| Icu423r | |
|
1101 W Guadalupe Rd Ste 1 Mesa AZ 85210-7601 | |
| (480) 788-5621 | |
| (480) 779-1277 |
| Full Name | Icu423r |
|---|---|
| Speciality | Integrative Medicine |
| Location | 1101 W Guadalupe Rd Ste 1, Mesa, Arizona |
| Authorized Official Name and Position | Kiup A Kim (OWNER) |
| Authorized Official Contact | 6027306438 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Icu423r 202 E Earll Dr Ste 360 Phoenix AZ 85012-2677 Ph: (480) 788-5621 | Icu423r 1101 W Guadalupe Rd Ste 1 Mesa AZ 85210-7601 Ph: (480) 788-5621 |
| NPI Number | 1528752300 |
|---|---|
| Provider Enumeration Date | 06/06/2023 |
| Last Update Date | 06/06/2023 |
| Certification Date | 06/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528752300 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 202D00000X | Integrative Medicine | (* (Not Available)) | Primary |
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