Healthcare Provider Details

I. General information

NPI: 1215497391
Provider Name (Legal Business Name): JANET KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 E MONTEREY WAY STE A
PHOENIX AZ
85012-2628
US

IV. Provider business mailing address

52 E MONTEREY WAY STE A
PHOENIX AZ
85012-2628
US

V. Phone/Fax

Practice location:
  • Phone: 602-604-9500
  • Fax: 602-631-9303
Mailing address:
  • Phone: 602-604-9500
  • Fax: 602-631-9303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number73939
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number73939
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: