Provider Demographics
NPI:1447472683
Name:PANDA MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:PANDA MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIOMA
Authorized Official - Middle Name:N
Authorized Official - Last Name:IWEHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-241-9028
Mailing Address - Street 1:6760 W THUNDERBIRD RD STE E100
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5048
Mailing Address - Country:US
Mailing Address - Phone:623-241-9028
Mailing Address - Fax:623-241-9029
Practice Address - Street 1:6760 W THUNDERBIRD RD STE E100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5048
Practice Address - Country:US
Practice Address - Phone:623-241-9028
Practice Address - Fax:623-241-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26965174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ79530Medicare ID - Type Unspecified