Provider Demographics
NPI:1164871075
Name:CENTRAL ARIZONA GI & LIVER INSTITUTE LLC
Entity type:Organization
Organization Name:CENTRAL ARIZONA GI & LIVER INSTITUTE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAE
Authorized Official - Middle Name:HO
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-393-0575
Mailing Address - Street 1:4001 E BASELINE RD STE 102-103
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2726
Mailing Address - Country:US
Mailing Address - Phone:480-565-8045
Mailing Address - Fax:480-407-6551
Practice Address - Street 1:4001 E BASELINE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2726
Practice Address - Country:US
Practice Address - Phone:480-565-8045
Practice Address - Fax:480-407-6551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL ARIZONA GI & LIVER INSTITUTE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-10
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy