Provider Demographics
NPI:1801039813
Name:PHOENIX FIRST ASSISTS LLC
Entity Type:Organization
Organization Name:PHOENIX FIRST ASSISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAO
Authorized Official - Middle Name:KENITH
Authorized Official - Last Name:FANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-253-9168
Mailing Address - Street 1:3131 E CLARENDON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7069
Mailing Address - Country:US
Mailing Address - Phone:602-253-9168
Mailing Address - Fax:602-251-3126
Practice Address - Street 1:3131 E CLARENDON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7069
Practice Address - Country:US
Practice Address - Phone:602-253-9168
Practice Address - Fax:602-251-3126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ421193Medicaid
AZZ132659Medicare PIN