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General NPI Number Information
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NPI Number | 1366600322
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Entity Type | Individual
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Provider Name | KEN K KWOK M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 1384 BATTLEFIELD PKWY
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-4010
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Country | US
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Telephone | 706-858-8083
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Fax | 706-861-2745
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Provider Business Mailing Address
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Address Line | 869 TRAILSIDE LN SW
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City | MARIETTA
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State | GA
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Zip | 30064-3077
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Country | US
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Telephone | 770-427-0005
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Fax | 770-427-0260
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 22808
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License Number State | GA
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