OrganizationActive
Advanced Minimally Invasive Surgical
NPI 1558119602 · Vascular Surgery Physician · Prescott, AZ
Provider details
- NPI number
- 1558119602
- Entity type
- Organization
- Primary specialty
- Vascular Surgery PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Advanced Minimally Invasive Surgical
- Organization subpart
- Yes
- Authorized official
- Kiup Kim, Owner(480) 323-6072
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(56/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
2 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
412 Whipple St
Prescott, AZ 86301-1712
Phone: (480) 788-5621
Fax: (480) 779-1277
Street-level locationGet directions
Mailing address
202 E Earll Dr Ste 360
Phoenix, AZ 85012-2677
Registry dates
- Enumerated
- 2024-05-13
- Last updated
- 2024-05-13
- Certified
- 2024-05-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.