Healthcare Provider Details

I. General information

NPI: 1407545205
Provider Name (Legal Business Name): HOANG NHAT PHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HELIX: 30 N MARIO CAPECCHI DR RM 3N100
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

HELIX: 30 N MARIO CAPECCHI DR RM 3N100
SALT LAKE UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-7676
  • Fax: 801-587-7290
Mailing address:
  • Phone: 801-585-7676
  • Fax: 801-587-7290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number14281008-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: