Provider Demographics
NPI:1053557470
Name:WONDER ARCH, INC.
Entity type:Organization
Organization Name:WONDER ARCH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:C-PED
Authorized Official - Phone:801-553-0161
Mailing Address - Street 1:834 E 9400 S STE 65
Mailing Address - Street 2:C/O FOOT SOLUTIONS
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-4111
Mailing Address - Country:US
Mailing Address - Phone:801-553-0161
Mailing Address - Fax:801-553-0171
Practice Address - Street 1:834 E 9400 S STE 65
Practice Address - Street 2:C/O FOOT SOLUTIONS
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-4111
Practice Address - Country:US
Practice Address - Phone:801-553-0161
Practice Address - Fax:801-553-0171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6230180001Medicare NSC