NPIMap

Organization Active NPI

Glendale Redbird Co

  • Driver
  • Glendale, AZ
National Provider Identifier
1780489112
Registry record updated Feb 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DriverTaxonomy code 172A00000X
Legal business name
GLENDALE REDBIRD CO
Practice address
6637 N 58TH Dr Apt 3
Glendale, AZ 85301-3900
Phone
(480) 918-4775
NPI assigned
Feb 18, 2025
Last updated
Feb 18, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
RADADVANTAGE A PROFESSIONAL CORP.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mydung Phan, RDN, RNNPI 1245065945
Title
Ceo
Phone
(480) 918-4775

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Driver 172A00000X NU Primary

Addresses

Primary practice location

6637 N 58TH Dr Apt 3
Glendale, AZ 85301-3900

Mailing address

6637 N 58TH Dr Apt 3
Glendale, AZ 85301-3900
Phone (480) 918-4775

Other identifiers 1

IdentifierTypeStateIssuer
167030MedicaidAZ

Other names 1

  • RADADVANTAGE A PROFESSIONAL CORP. Other name

National Provider Directory

National Provider Directory
Tax ID family
Glendale Redbird Co2 organizations share this tax ID, including this one
Part of
Glendale Redbird Co

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1739836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739836800000",
    "number": "1780489112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6637 N 58TH DR APT 3",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853013900",
            "telephone_number": "480-918-4775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6637 N 58TH DR APT 3",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853013900",
            "telephone_number": "480-918-4775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE REDBIRD CO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RADADVANTAGE A PROFESSIONAL CORP.",
        "enumeration_date": "2025-02-18",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-18",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "MYDUNG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-918-4775",
        "authorized_official_credential": "RDN, RN"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167030",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RADADVANTAGE A PROFESSIONAL CORP.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.