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General NPI Number Information
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NPI Number | 1265888473
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Entity Type | Individual
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Provider Name | KYONG KIM D.P.M
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Gender | Male
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 18151 NE 31ST CT APT 911
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City | AVENTURA
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State | FL
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Zip | 33160-2660
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Country | US
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Telephone | 786-617-2905
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Fax |
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Provider Business Mailing Address
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Address Line | 222 E 44TH ST APT 29F
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City | NEW YORK
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State | NY
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Zip | 10017-4467
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Country | US
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Telephone | 786-617-2905
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | N007015
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License Number State | NY
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