Healthcare Provider Details

I. General information

NPI: 1184543985
Provider Name (Legal Business Name): KADYN JANAE MUNK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 W PRICE AVE
SOUTH SALT LAKE UT
84115-4345
US

IV. Provider business mailing address

177 W PRICE AVE
SOUTH SALT LAKE UT
84115-4345
US

V. Phone/Fax

Practice location:
  • Phone: 801-834-9028
  • Fax:
Mailing address:
  • Phone: 801-834-9028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberF-26-148134
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: