Most Relevant Information
Provider Data
| NPI Number: | 1003494683 |
| Provider Name: | YURY FOMIN MD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/01/2021 |
| Last Updated: | 04/01/2021 |
Provider Practice Location
1300 N 12TH ST STE 508
PHOENIX
AZ
850062849
Practice Location Phone/Fax
| Phone: | 6028393927 |
| Fax: | 6028394233 |
Provider Mailing Location
1300 N 12TH ST STE 508
PHOENIX
AZ
850062849
Provider Mailing Phone/Fax
| Phone: | 6028393927 |
| Fax: | 6028394233 |