Healthcare Provider Details

I. General information

NPI: 1477403533
Provider Name (Legal Business Name): KENT WIENZVEG HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13934 N 59TH AVE STE 120
GLENDALE AZ
85306-4168
US

IV. Provider business mailing address

13934 N 59TH AVE STE 120
GLENDALE AZ
85306-4168
US

V. Phone/Fax

Practice location:
  • Phone: 602-978-5187
  • Fax: 602-654-3657
Mailing address:
  • Phone: 602-978-5187
  • Fax: 602-654-3657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADE17006
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: