Provider Demographics
NPI:1952399180
Name:VIJUNGCO, JOSEPH D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:D
Last Name:VIJUNGCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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
Practice Address - Street 2:STE D-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
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ359882086S0129X, 2086S0129X
NV11099208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ144951Medicaid
I13544Medicare UPIN
AZZ152435Medicare PIN