Healthcare Provider Details

I. General information

NPI: 1578918066
Provider Name (Legal Business Name): NATHAN KANYINDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E OSBORN RD STE 100
PHOENIX AZ
85012-2347
US

IV. Provider business mailing address

300 E OSBORN RD STE 100
PHOENIX AZ
85012-2347
US

V. Phone/Fax

Practice location:
  • Phone: 480-994-5012
  • Fax: 480-994-9479
Mailing address:
  • Phone: 480-994-5012
  • Fax: 480-994-9479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number70313
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD2020-0842
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number70313
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: