Healthcare Provider Details

I. General information

NPI: 1780507517
Provider Name (Legal Business Name): WTN HEALTH OF ARIZONA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41810 N VENTURE DR STE E152
ANTHEM AZ
85086-3176
US

IV. Provider business mailing address

PO BOX 202387
DALLAS TX
75320-2387
US

V. Phone/Fax

Practice location:
  • Phone: 954-923-7440
  • Fax: 954-923-1299
Mailing address:
  • Phone: 954-923-7440
  • Fax: 954-923-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MINGHSUN LIU
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 310-570-2198