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General NPI Number Information
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NPI Number | 1043428253
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Entity Type | Individual
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Provider Name | YONG-HAN KOO D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2007
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 241 BOSTON POST RD STE 2
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City | WAYLAND
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State | MA
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Zip | 01778-1836
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Country | US
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Telephone | 508-276-1222
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Fax |
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Provider Business Mailing Address
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Address Line | 241 BOSTON POST RD STE 2
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City | WAYLAND
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State | MA
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Zip | 01778-1836
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Country | US
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Telephone | 508-276-1222
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN22058
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License Number State | MA
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