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General NPI Number Information
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NPI Number | 1295833192
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Entity Type | Individual
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Provider Name | MIN CHEOL KIM MD
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Gender | Male
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14155 NORTH 83RD AVENUE SUITE 1103
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City | PEORIA
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State | AZ
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Zip | 85381
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Country | US
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Telephone | 480-495-6492
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11977
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City | GLENDALE
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State | AZ
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Zip | 85318-1977
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Country | US
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Telephone | 480-495-6492
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 36025
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License Number State | AZ
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