Healthcare Provider Details

I. General information

NPI: 1891805735
Provider Name (Legal Business Name): DEPARTMENT OF VETERAN AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL ROAD
PHOENIX AZ
85012-1892
US

IV. Provider business mailing address

650 E INDIAN SCHOOL ROAD
PHOENIX AZ
85012-1892
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax: 602-212-2192
Mailing address:
  • Phone: 602-277-5551
  • Fax: 602-212-2192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA31005
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberA-31005
License Number StateCA

VIII. Authorized Official

Name: DR. MING DER LEE
Title or Position: STAFF PHYSICIAN
Credential: M.D
Phone: 602-277-5551