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General NPI Number Information
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NPI Number | 1417943309
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Entity Type | Individual
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Provider Name | CHUL SOO KWON M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 06/09/2019
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Provider Practice Location Address
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Address Line | 711 W 40TH ST STE 406
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City | BALTIMORE
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State | MD
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Zip | 21211
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Country | US
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Telephone | 410-235-2880
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Fax | 410-465-1436
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Provider Business Mailing Address
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Address Line | 2908 CHAINITA CT
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-7625
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Country | US
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Telephone | 443-413-6752
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Fax | 410-465-1436
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D0018904
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License Number State | MD
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