MEDICARE: HUONG T PHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	12562785-1206	UT
2	390200000X	Student in an Organized Health Care Education/Training Program
3	363A00000X	Physician Assistant	12562785-1206	UT

General Provider Information

NPI Number	:	1144845108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUONG T PHAM

Provider Business Mailing Address
First Line	:	319 E BELDON PL
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-3516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3336 S PIONEER PKWY STE 302
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-2074
Country	:	US
Telephone Number	:	801-964-8726
Fax Number	:	801-968-9836

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2020
Last Update Date	:	12/08/2024

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Directions to “ HUONG T PHAM ” Practice Location

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