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General NPI Number Information
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NPI Number | 1013415678
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Entity Type | Organization
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Legal Business Name | PROMISE INTEGRATIVE MEDICINE CLINIC RI
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Dates
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Enumeration Date | 01/30/2018
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Last Update Date | 01/30/2018
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Provider Practice Location Address
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Address Line | 2095 ELMWOOD AVE STE 1
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City | WARWICK
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State | RI
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Zip | 02888-2405
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Country | US
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Telephone | 401-787-1608
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Fax | 401-633-7610
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Provider Business Mailing Address
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Address Line | 535 ROOSEVELT AVE APT 611
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City | CENTRAL FALLS
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State | RI
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Zip | 02863-3204
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF ACUPUNCTURE ORIENTAL MEDI
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Name | HYUN SOO YEO
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Credential | DAOM
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Telephone | 213-222-7481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | DAOM0056
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License Number State | RI
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