Provider Demographics
NPI:1790056505
Name:DISCOVER VEIN AND VASCULAR CENTER PLLC
Entity Type:Organization
Organization Name:DISCOVER VEIN AND VASCULAR CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:VIJUNGCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-745-8577
Mailing Address - Street 1:1900 W CHANDLER BLVD
Mailing Address - Street 2:STE 15-255
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-8632
Mailing Address - Country:US
Mailing Address - Phone:480-745-8577
Mailing Address - Fax:480-745-8677
Practice Address - Street 1:1840 W CHANDLER BLVD STE D-2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6201
Practice Address - Country:US
Practice Address - Phone:480-745-8577
Practice Address - Fax:480-745-8677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ676331Medicaid
AZZ152434Medicare PIN