Healthcare Provider Details

I. General information

NPI: 1427225986
Provider Name (Legal Business Name): DR. ANDREI BALANDIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 W BEVERLY LN
GLENDALE AZ
85306-1800
US

IV. Provider business mailing address

PO BOX 60691
CITY OF INDUSTRY CA
91716-0691
US

V. Phone/Fax

Practice location:
  • Phone: 623-312-3000
  • Fax: 623-312-3060
Mailing address:
  • Phone: 480-821-2838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number49189
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: