Organization
MYDUNG PHAN
Active
Parent organization
RADADVANTAGE A PROFESSIONAL CORPORATION
Other names
Mydung Thi Phan, Mydung Phan
Organization subpart
Yes
Provider details
NPI number
Legal business name
RADADVANTAGE A PROFESSIONAL CORPORATION
Authorized official
MYDUNG THI PHAN RDN (REGISTERED NUTRIONIST)
(480) 918-4775
Entity
Organization
Contact information
Practice address
6637 N 58TH DR APT 3, GLENDALE, AZ 85301-3900
(480) 918-4775
Mailing address
6637 N 58TH DR APT 3, GLENDALE, AZ 85301-3900
(480) 918-4775
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
—
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
—
136A00000X
Registered Dietetic Technician
—
—
171400000X
Health & Wellness Coach
—
—
172A00000X
Driver
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167030
—
AZ
Enumeration date
02/12/2025
Last updated
02/16/2025
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