Organization
ENDOVASCULAR
Active
Other names
Endovascular
Organization subpart
No
Provider details
NPI number
Authorized official
KIUP ALEXANDER KIM MD (CHIEF MEDICAL OFFICER)
(480) 584-2369
Entity
Organization
Contact information
Practice address
2240 COLLEGE DR, GALLUP, NM 87301-7003
(505) 297-1052
(505) 297-1227
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
207QB0002X
Obesity Medicine (Family Medicine) Physician
—
—
208600000X
Surgery Physician
Primary
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
Other
Enumeration date
08/15/2022
Last updated
09/08/2022
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