Healthcare Provider Details

I. General information

NPI: 1063845360
Provider Name (Legal Business Name): KOYUN CHI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICE CHI PHD

II. Dates (important events)

Enumeration Date: 08/10/2013
Last Update Date: 12/06/2021
Certification Date: 11/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 N SCOTTSDALE RD STE C190
SCOTTSDALE AZ
85253-3754
US

IV. Provider business mailing address

7144 S 7TH LN
PHOENIX AZ
85041-6765
US

V. Phone/Fax

Practice location:
  • Phone: 480-448-6571
  • Fax: 480-771-5858
Mailing address:
  • Phone: 650-274-1905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY5332
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: