Provider Demographics
NPI:1104399641
Name:KYM FAMILY LLC
Entity Type:Organization
Organization Name:KYM FAMILY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGEERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-297-3228
Mailing Address - Street 1:6732 E MORELAND ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3246
Mailing Address - Country:US
Mailing Address - Phone:480-297-3228
Mailing Address - Fax:
Practice Address - Street 1:6732 E MORELAND ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3246
Practice Address - Country:US
Practice Address - Phone:480-297-3228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty