Healthcare Provider Details

I. General information

NPI: 1164871075
Provider Name (Legal Business Name): CENTRAL ARIZONA GI & LIVER INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 E BASELINE RD SUITE 102
GILBERT AZ
85234-2726
US

IV. Provider business mailing address

4001 E BASELINE RD STE 102-103
GILBERT AZ
85234-2726
US

V. Phone/Fax

Practice location:
  • Phone: 480-565-8045
  • Fax: 480-407-6551
Mailing address:
  • Phone: 480-565-8045
  • Fax: 480-407-6551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAE HO KIM
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 480-393-0575