Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Phong Ta

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1083298509

Phong Ta is a Podiatry in Phoenix, Arizona. Qualified in 2021, 5 years ago. Practices with Desert Mobile Foot Care LLC, a 5-clinician group and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
5
Licensed in
AZ
In the registry since
2021
Specialties on file
2
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Practice location Address checks out

7301 N 16th St Ste 202
Phoenix, AZ 85020-5265
Phone: (602) 753-2345
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Podiatrist (primary) Taxonomy 213E00000X · Licence POD-001122. (AZ)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1083298509
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMay 11, 2021
Last updated in NPPESAugust 6, 2024
Certification dateAugust 6, 2024
Mailing address1721 Castlegate Dr, San Jose, CA 95132-1712

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPODIATRY
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Desert Mobile Foot Care Llc — 5 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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