Basic Information
| Provider Information | |||||||||
| NPI: | 1497373500 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARADIGM PSYCHIATRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 S KYRENE RD STE 4 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852264687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806139599 | ||||||||
| FaxNumber: | 4809008515 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 S KYRENE RD STE 4 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852264687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804159305 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2020 | ||||||||
| LastUpdateDate: | 08/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | JUNG | ||||||||
| AuthorizedOfficialFirstName: | KIONGLEE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 4806139599 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DNP | ||||||||
| NPICertificationDate: | 08/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.