Provider Demographics
NPI:1144439555
Name:THONGTRANGAN, ISSADA (MD)
Entity type:Individual
Prefix:DR
First Name:ISSADA
Middle Name:
Last Name:THONGTRANGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4070 E LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3922
Mailing Address - Country:US
Mailing Address - Phone:602-818-5214
Mailing Address - Fax:602-610-3878
Practice Address - Street 1:14300 N NORTHSIGHT BLVD STE 213
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3677
Practice Address - Country:US
Practice Address - Phone:602-833-2141
Practice Address - Fax:602-610-3878
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45920207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ45920OtherMEDICAL LICENSE