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MYDUNG PHAN
NPI 1083429369
Peer Specialist in Glendale, AZ

Active since February 12, 2025
6637 N 58TH DR APT 3, GLENDALE, AZ 85301(480) 918-4775 Get Directions Write a Review

NPPES record last updated: February 16, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mydung Phan NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MYDUNG PHAN (NPI 1083429369) is a healthcare organization registered as a peer specialist in Glendale, Arizona and active in the NPI registry since February 2025. The organization lists Mydung Thi Phan, Registered Nutrionist, as its authorized official.

NPPES Registry Identity

NPI1083429369
Entity TypeOrganization
Primary Taxonomy175T00000X
Legal Business NameMYDUNG PHAN
Location Address6637 N 58TH DR APT 3Glendale, AZ 85301-3900
Mailing Address6637 N 58th Dr Apt 3Glendale, AZ 85301-3900 · (480) 918-4775
Phone(480) 918-4775
Organization SubpartYesParent: Radadvantage A Professional Corporation
Authorized OfficialMydung Thi PhanRegistered Nutrionist · (480) 918-4775
Enumeration DateFebruary 12, 2025
Last NPPES UpdateFebruary 16, 2025
NPPES CertifiedFebruary 16, 2025
✔ NPI 1083429369 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtyPeer SpecialistOther Service Providers
Taxonomy Code175T00000X
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
Also ListedNutritionistTaxonomy 133N00000X
Also ListedDietitian, Registered · Nutrition, Obesity and Weight ManagementTaxonomy 133VN1201X
Also ListedDietetic Technician, RegisteredTaxonomy 136A00000X
Also ListedHealth and Wellness CoachTaxonomy 171400000X
Also ListedDriverTaxonomy 172A00000X
6637 N 58TH DR APT 3, Glendale, AZ 85301
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Other Names 2

Doing Business AsMydung Phan
Other NameMydung Thi Phan

Other Identifiers 1

Medicaid167030AZ

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MYDUNG T PHAN NUTRITIONIST
Driver
6637 N 58TH DR APT 3
GLENDALE, AZ 85301
Maricopa County (623) 624-5179
GLENDALE REDBIRD CO
Driver
6637 N 58TH DR APT 3
GLENDALE, AZ 85301
Maricopa County (480) 918-4775

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mydung Phan's NPI number?

The NPI number for Mydung Phan is 1083429369. It was assigned to this organization in the NPPES registry on February 12, 2025. The provider is also known as Mydung Thi Phan.

Where is Mydung Phan located?

Mydung Phan is located at 6637 N 58th Dr Apt 3, Glendale, AZ 85301. The listed phone number is (480) 918-4775.

What is Mydung Phan's specialty?

The primary specialty registered for this NPI is Peer Specialist with taxonomy code 175T00000X.

When was this NPI record last updated?

The NPPES record for Mydung Phan was last updated on February 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.