Mydung Phan
Mydung Phan is a healthcare organization registered as Peer Specialist in Glendale, AZ, holding Type 2 (organization) NPI 1083429369 since 2025. The authorized official on file is Mydung Phan, Registered Nutrionist.
✓ Active NPI ✓ Valid NPI checksum Organization subpart
| NPI | 1083429369 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Mydung Phan |
| Parent organization | Radadvantage A Professional Corporation |
| Practice address | 6637 N 58TH DR APT 3, Glendale, AZ, 85301 |
| Phone | 4809184775 |
| Enumeration date | 2025-02-12 |
| Last updated in NPPES | 2025-02-16 |
Authorized official
| Name | Mydung Phan |
|---|---|
| Title | Registered Nutrionist |
| Phone | 4809184775 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 136A00000X | Registered Dietetic Technician | Secondary | — | — |
| 171400000X | Health & Wellness Coach | Secondary | — | — |
| 172A00000X | Driver | Secondary | — | — |
| 133N00000X | Nutritionist | Secondary | — | — |
| 133VN1201X | Obesity and Weight Management Nutrition Registered Dietitian | Secondary | — | — |
| 175T00000X | Peer Specialist | Primary | — | — |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 167030 | Medicaid | AZ | — |
Copy-ready billing details
Provider: Mydung Phan NPI: 1083429369 Taxonomy: 175T00000X (Peer Specialist) Address: 6637 N 58TH DR APT 3, Glendale, AZ, 85301
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1245065945 | Mydung Phan | Individual | Driver | Glendale, AZ |
| 1780489112 | Glendale Redbird Co | Organization | Driver | Glendale, AZ |
Verify this record
Cross-check NPI 1083429369 against the authoritative CMS record: view Mydung Phan on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
Who is the authorized official for Mydung Phan?
What is the NPI number for Mydung Phan?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2025-02-16.