Healthcare Provider Details

I. General information

NPI: 1275486326
Provider Name (Legal Business Name): CHANDLER CADE KOHUTEK PA-S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 S CHIPETA WAY STE 22
SALT LAKE CITY UT
84108-1234
US

IV. Provider business mailing address

1063 S 55 W
FARMINGTON UT
84025-2114
US

V. Phone/Fax

Practice location:
  • Phone: 385-228-8599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: