Provider Demographics
NPI:1093596876
Name:PHANDINH CLINIC-URGENT CARE & WELLNESS CENTER PC
Entity Type:Organization
Organization Name:PHANDINH CLINIC-URGENT CARE & WELLNESS CENTER PC
Other - Org Name:PHANDINH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHANDINH
Authorized Official - Middle Name:N
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:NMD, MD
Authorized Official - Phone:206-356-6313
Mailing Address - Street 1:5406 W GLENN DR STE 3
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-2662
Mailing Address - Country:US
Mailing Address - Phone:623-270-6336
Mailing Address - Fax:
Practice Address - Street 1:5406 W GLENN DR STE 3
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-2662
Practice Address - Country:US
Practice Address - Phone:623-270-6336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care