Provider Demographics
NPI:1083179014
Name:HOPE CLINIC OF INTEGRATIVE MEDICINE, LLC
Entity Type:Organization
Organization Name:HOPE CLINIC OF INTEGRATIVE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OKKY
Authorized Official - Middle Name:
Authorized Official - Last Name:OEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-269-9220
Mailing Address - Street 1:15030 N HAYDEN RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2564
Mailing Address - Country:US
Mailing Address - Phone:480-269-9220
Mailing Address - Fax:
Practice Address - Street 1:208 W CHANDLER HEIGHTS RD # 101
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-5065
Practice Address - Country:US
Practice Address - Phone:480-269-9220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty