Healthcare Provider Details

I. General information

NPI: 1174427892
Provider Name (Legal Business Name): HAVASU HOUSE CALL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 CARAVELLE DR
LAKE HAVASU CITY AZ
86406-6144
US

IV. Provider business mailing address

3180 CARAVELLE DR
LAKE HAVASU CITY AZ
86406-6144
US

V. Phone/Fax

Practice location:
  • Phone: 512-970-1629
  • Fax:
Mailing address:
  • Phone: 512-970-1629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. YUN KIM
Title or Position: OWNER
Credential: MD
Phone: 512-970-1629