Provider Demographics
NPI:1497397814
Name:INTEGRATIVE UROLOGY PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE UROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOON
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-900-8003
Mailing Address - Street 1:2222 E HIGHLAND AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4876
Mailing Address - Country:US
Mailing Address - Phone:602-900-8003
Mailing Address - Fax:602-900-8580
Practice Address - Street 1:2222 E HIGHLAND AVE STE 206
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4876
Practice Address - Country:US
Practice Address - Phone:602-900-8003
Practice Address - Fax:602-900-8580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty