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Contact Information

MYDUNG PHAN
6637 N 58TH DR APT 3
GLENDALE, AZ85301-3900
 Phone: 480-918-4775
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Other Service Providers

175T00000X
 

Dietetic Technician, Registered

136A00000X
 

Driver

172A00000X
 

Health & Wellness Coach

171400000X
 

Nutrition, Obesity and Weight Management

133VN1201X 71 Registered Dietitian or Nutrition Professional
 

Nutritionist

133N00000X
Indicates primary specialty

NPI Profile & details for MYDUNG PHAN · (Female)

NPI # 1083429369
Status Active
Credentials
Entity Individual
Enumeration date 02/12/2025
Last updated 02/16/2025 - More than a year ago
Sole proprietor 1 Not specified
Identifiers
  • AZ Medicaid 167030
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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