Healthcare Provider Details

I. General information

NPI: 1144845108
Provider Name (Legal Business Name): HUONG T PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 12/08/2024
Certification Date: 12/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3336 S PIONEER PKWY STE 302
WEST VALLEY CITY UT
84120-2074
US

IV. Provider business mailing address

319 E BELDON PL
SALT LAKE CITY UT
84111-3516
US

V. Phone/Fax

Practice location:
  • Phone: 801-964-8726
  • Fax: 801-968-9836
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12562785-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number12562785-1206
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: