Organization
ICU423R
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIUP A KIM MD (OWNER)
(602) 730-6438
Entity
Organization
Contact information
Practice address
1101 W GUADALUPE RD STE 1, MESA, AZ 85210-7601
(480) 788-5621
(480) 779-1277
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
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
06/06/2023
Last updated
06/06/2023
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