Healthcare Provider Details

I. General information

NPI: 1912311192
Provider Name (Legal Business Name): KAMUN CHAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E SOUTH TEMPLE
SALT LAKE CITY UT
84102-1507
US

IV. Provider business mailing address

1050 E SOUTH TEMPLE
SALT LAKE CITY UT
84102-1507
US

V. Phone/Fax

Practice location:
  • Phone: 801-350-4111
  • Fax:
Mailing address:
  • Phone: 801-350-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberV2868
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number12013387-1204
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number297774-01
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12013387-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: