# SIP HOME SYSTEMS - MESA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780215681
- **Authorized official:** KENNY MAI (MD)
- **Authorized official phone:** (623) 374-7774

## Contact information

- **Practice address:** 24TH AT CAMELBACK, 2375 E. CAMELBACK RD., SUITE 600, PHOENIX, AZ 85016
- **Practice address phone:** (623) 374-7774
- **Mailing address:** 24TH AT CAMELBACK, 2375 E. CAMELBACK RD., SUITE 600, PHOENIX, AZ 85016-2111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 251E00000X | Home Health Agency | — | NULL | — |

## Other

- **Enumeration date:** 01/29/2020
- **Last updated:** 04/30/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ========= | — | AZ |