Provider Demographics
NPI:1932245974
Name:ASSURED IMAGING WOMEN'S WELLNESS OF SOUTHERN ARIZONA, LLC
Entity Type:Organization
Organization Name:ASSURED IMAGING WOMEN'S WELLNESS OF SOUTHERN ARIZONA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-774-8828
Mailing Address - Street 1:7717 N HARTMAN LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-9506
Mailing Address - Country:US
Mailing Address - Phone:520-744-6121
Mailing Address - Fax:520-572-7138
Practice Address - Street 1:7717 N HARTMAN LN
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-9506
Practice Address - Country:US
Practice Address - Phone:520-744-6121
Practice Address - Fax:520-572-7138
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSURED IMAGING WOMEN'S WELLNESS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MobileGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ121285Medicare PIN
AZZ121285Medicare PIN