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General NPI Number Information
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NPI Number | 1417734229
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Entity Type | Organization
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Legal Business Name | DREAM VEIN CLINIC PLLC
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Dates
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Enumeration Date | 09/13/2023
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 1601 E PFLUGERVILLE PKWY BLDG 3
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-2799
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Country | US
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Telephone | 206-450-6845
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 E PFLUGERVILLE PKWY STE 3201
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-7349
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Country | US
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Telephone | 206-450-6845
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JASMINE JAMIN KOO
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Credential | MD
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Telephone | 206-450-6845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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