NPIMap

Advanced Minimally Invasive Surgical

Organization Active NPI Vascular Surgery Physician · Chandler, AZ

NPI 1750139804 · NPPES record last updated May 13, 2024

Key facts

NPI
1750139804
Entity type
Organization (NPI type 2)
Primary specialty
Vascular Surgery Physician 2086S0129X
Legal business name
ADVANCED MINIMALLY INVASIVE SURGICAL
Practice address
1455 W Chandler Blvd Ste B11
Chandler, AZ 85224-6128
Phone
(480) 788-5621
Fax
(480) 779-1277
NPI assigned
May 13, 2024
Organization subpart
Yes
Parent organization (as reported)
ADVANCED MINIMALLY INVASIVE SURGICAL

Authorized official

Name
Kiup Alexander Kim, MD NPI 1225242985
Title
Owner
Phone
(480) 323-6072

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Corporate family (same tax ID) 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Tax ID family
Advanced Minimally Invasive Surgical (6 organizations share this tax ID)
Part of
Advanced Minimally Invasive Surgical

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2086S0129X Yes

Addresses

Primary practice location

1455 W Chandler Blvd Ste B11
Chandler, AZ 85224-6128

Mailing address

202 E Earll Dr Ste 360
Phoenix, AZ 85012-2677
Phone (480) 788-5621

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 13, 2024.

{
    "created_epoch": "1715558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715558400000",
    "number": "1750139804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 E EARLL DR STE 360",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122677",
            "telephone_number": "480-788-5621",
            "fax_number": "480-779-1277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 W CHANDLER BLVD STE B11",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852246128",
            "telephone_number": "480-788-5621",
            "fax_number": "480-779-1277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED MINIMALLY INVASIVE SURGICAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVANCED MINIMALLY INVASIVE SURGICAL",
        "enumeration_date": "2024-05-13",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "KIUP",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-323-6072",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

All providers in Chandler, AZ · Vascular Surgery Physician in Arizona

Sources for this page

Verify at the official NPI Registry.