Provider Demographics
NPI:1871522524
Name:FANG, HAO KENITH (MD)
Entity type:Individual
Prefix:
First Name:HAO
Middle Name:KENITH
Last Name:FANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3131 E CLARENDON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7069
Mailing Address - Country:US
Mailing Address - Phone:602-253-9168
Mailing Address - Fax:602-251-3126
Practice Address - Street 1:3131 E CLARENDON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7069
Practice Address - Country:US
Practice Address - Phone:602-253-9168
Practice Address - Fax:602-251-3126
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28335208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ507072Medicaid
AZ507072Medicaid
Z61979Medicare PIN