Organization
OBL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIUP KIM MD (FOUNDER / CEO)
(480) 788-5621
Entity
Organization
Contact information
Practice address
14804 N CAVE CREEK RD STE 200, PHOENIX, AZ 85032-4945
(480) 240-5613
(480) 205-1063
Mailing address
202 E EARLL DR STE 360, PHOENIX, AZ 85012-2677
(480) 788-5621
(480) 779-1277
Taxonomy
Speciality
Code
Description
License number
State
202D00000X
Integrative Medicine Physician
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
208600000X
Surgery Physician
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
92926
—
AZ
Enumeration date
05/13/2021
Last updated
05/04/2023
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