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General NPI Number Information
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NPI Number | 1174758429
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Entity Type | Individual
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Provider Name | ALBERT JUN PAHK MD
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Gender | Male
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Dates
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Enumeration Date | 05/15/2009
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Last Update Date | 02/02/2011
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Provider Practice Location Address
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Address Line | 13630 MAPLE AVE STE 1D
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City | FLUSHING
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State | NY
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Zip | 11355-3866
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Country | US
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Telephone | 718-939-8705
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Fax | 718-939-8712
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Provider Business Mailing Address
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Address Line | 13630 MAPLE AVE STE 1D
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City | FLUSHING
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State | NY
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Zip | 11355-3866
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Country | US
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Telephone | 718-939-8705
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Fax | 718-939-8712
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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 | MD037983
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 238408-1
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License Number State | NY
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