Healthcare Provider Details

I. General information

NPI: 1518654326
Provider Name (Legal Business Name): LAUREN T. PHAM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 S CHIPETA WAY STE A
SALT LAKE CITY UT
84108-1261
US

IV. Provider business mailing address

375 S CHIPETA WAY STE A
SALT LAKE CITY UT
84108-1261
US

V. Phone/Fax

Practice location:
  • Phone: 801-824-1886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number14174814-1204
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14174814-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: