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General NPI Number Information
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NPI Number | 1154361434
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Entity Type | Individual
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Provider Name | CHARLES S. KIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 631 CLEVELAND AVE S STE 5
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City | SAINT PAUL
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State | MN
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Zip | 55116-1244
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Country | US
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Telephone | 984-377-3422
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11839
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City | SAINT PAUL
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State | MN
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Zip | 55111-0839
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Country | US
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Telephone | 984-377-3422
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Fax | 855-740-1940
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 41236
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 41236
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 57253
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License Number State | MN
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