Healthcare Provider Details

I. General information

NPI: 1841223088
Provider Name (Legal Business Name): PHOENIX VEIN INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 E MCDOWELL RD SUITE 400
PHOENIX AZ
85006-2664
US

IV. Provider business mailing address

1144 E MCDOWELL RD SUITE 400
PHOENIX AZ
85006-2664
US

V. Phone/Fax

Practice location:
  • Phone: 602-253-9168
  • Fax: 602-251-3126
Mailing address:
  • Phone: 602-253-9168
  • Fax: 602-251-3126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: HAO KENITH FANG
Title or Position: OWNER
Credential: MD
Phone: 602-253-9168