Healthcare Provider Details

I. General information

NPI: 1275344426
Provider Name (Legal Business Name): ASSURED IMAGING WOMENS WELLNESS OF SOUTHERN ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7717 N HARTMAN LN
TUCSON AZ
85743-5800
US

IV. Provider business mailing address

7717 N HARTMAN LN
TUCSON AZ
85743-5800
US

V. Phone/Fax

Practice location:
  • Phone: 888-233-6121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JIN S KIM
Title or Position: CEO
Credential: MD
Phone: 312-774-8828