Provider Demographics
NPI:1447226899
Name:MARK, KENNETH BRIGHTON (CFA, SA-C)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:BRIGHTON
Last Name:MARK
Suffix:
Gender:M
Credentials:CFA, SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 SPRING CANYON RD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-5477
Mailing Address - Country:US
Mailing Address - Phone:801-991-0762
Mailing Address - Fax:
Practice Address - Street 1:5901 SPRING CANYON RD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5477
Practice Address - Country:US
Practice Address - Phone:801-513-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-26
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
97014246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist