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General NPI Number Information
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NPI Number | 1083429369
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Entity Type | Organization
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Legal Business Name | MYDUNG PHAN
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/16/2025
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Provider Practice Location Address
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Address Line | 6637 N 58TH DR APT 3
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City | GLENDALE
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State | AZ
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Zip | 85301-3900
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Country | US
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Telephone | 480-918-4775
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Fax |
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Provider Business Mailing Address
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Address Line | 6637 N 58TH DR APT 3
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City | GLENDALE
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State | AZ
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Zip | 85301-3900
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Country | US
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Telephone | 480-918-4775
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Fax |
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Authorized Official
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Title or Position | REGISTERED NUTRIONIST
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Name | MYDUNG THI PHAN
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Credential | RDN
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Telephone | 480-918-4775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 136A00000X
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Taxonomy Name | Registered Dietetic Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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