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General NPI Number Information
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NPI Number | 1023882586
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Entity Type | Individual
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Provider Name | YOON WEON SUH
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Gender | Female
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Dates
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Enumeration Date | 11/14/2023
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 223 BLOOMFIELD AVE
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City | NEWARK
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State | NJ
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Zip | 07104-1104
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Country | US
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Telephone | 973-435-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 AVENUE AT PORT IMPERIAL APT 423
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City | WEEHAWKEN
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State | NJ
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Zip | 07086-6988
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Country | US
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Telephone | 917-892-3866
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 063553
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22DI03001900
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License Number State | NJ
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