Provider Demographics
NPI:1508427667
Name:ARIZONA STATE UROLOGY LLC
Entity Type:Organization
Organization Name:ARIZONA STATE UROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIM TAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-337-8500
Mailing Address - Street 1:6525 W SACK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7106
Mailing Address - Country:US
Mailing Address - Phone:602-337-8500
Mailing Address - Fax:602-337-8151
Practice Address - Street 1:6525 W SACK DR STE 201
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7106
Practice Address - Country:US
Practice Address - Phone:602-337-8500
Practice Address - Fax:602-337-8151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty