Healthcare Provider Details

I. General information

NPI: 1841727013
Provider Name (Legal Business Name): THAI HOANG VU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 S PIERPONT DR
MESA AZ
85206-4697
US

IV. Provider business mailing address

3700 N 24TH ST STE 210
PHOENIX AZ
85016-6536
US

V. Phone/Fax

Practice location:
  • Phone: 602-844-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number010802
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20249
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number010802
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: