Healthcare Provider Details

I. General information

NPI: 1679401202
Provider Name (Legal Business Name): HAGAN HUYNH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

5557 W 4100 S
WEST VALLEY CITY UT
84120-4629
US

IV. Provider business mailing address

4132 S JOHN WAY
WEST VALLEY CITY UT
84120-4740
US

V. Phone/Fax

Practice location:
  • Phone: 801-966-1118
  • Fax: 801-212-9783
Mailing address:
  • Phone: 385-645-9803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10990665-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: