MEDICARE: PHOENIX VEIN INSTITUTE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841223088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX VEIN INSTITUTE PLLC

Provider Business Mailing Address
First Line	:	1144 E MCDOWELL RD
Second Line	:	SUITE 400
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2664
Country	:	US
Telephone Number	:	602-253-9168
Fax Number	:	602-251-3126

Provider Business Practice Location Address
First Line	:	1144 E MCDOWELL RD
Second Line	:	SUITE 400
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2664
Country	:	US
Telephone Number	:	602-253-9168
Fax Number	:	602-251-3126

Authorized Official
Title or Position	:	OWNER
Name	:	HAO KENITH FANG
Credential	:	MD
Telephone Number	:	602-253-9168

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	08/22/2020

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Directions to “PHOENIX VEIN INSTITUTE PLLC ” Practice Location

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