Healthcare Provider Details

I. General information

NPI: 1043120652
Provider Name (Legal Business Name): SARAH KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 S SIRRINE
MESA AZ
85210-1611
US

IV. Provider business mailing address

1025 N COUNTRY CLUB DR STE 111
MESA AZ
85201-3302
US

V. Phone/Fax

Practice location:
  • Phone: 480-472-5423
  • Fax:
Mailing address:
  • Phone: 480-472-3906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number307962
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: