Healthcare Provider Details

I. General information

NPI: 1629728001
Provider Name (Legal Business Name): ELLEN MARIE CHOI KAHN MSN-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3665 S 8400 W
MAGNA UT
84044-4907
US

IV. Provider business mailing address

604 N 1300 W
SALT LAKE CITY UT
84116-3873
US

V. Phone/Fax

Practice location:
  • Phone: 801-250-9638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16297280091
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: