Healthcare Provider Details

I. General information

NPI: 1184679037
Provider Name (Legal Business Name): AARON W KEMP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 E CHANDLER BLVD SUITE 304
PHOENIX AZ
85048-7643
US

IV. Provider business mailing address

4545 E CHANDLER BLVD SUITE 304
PHOENIX AZ
85048-7643
US

V. Phone/Fax

Practice location:
  • Phone: 480-961-2366
  • Fax: 480-961-2367
Mailing address:
  • Phone: 480-961-2366
  • Fax: 480-961-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29071
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: