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General NPI Number Information
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NPI Number | 1437783107
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Entity Type | Individual
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Provider Name | SAMUEL EUNGOOK KIM
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Gender | Male
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Dates
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Enumeration Date | 03/02/2020
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 385 S MAPLE AVE STE 207
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City | GLEN ROCK
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State | NJ
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Zip | 07452-1545
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Country | US
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Telephone | 201-380-2236
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Fax |
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Provider Business Mailing Address
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Address Line | 7 LINWOOD RD N
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-1411
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Country | US
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Telephone | 516-497-8068
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 14093
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 22DI03027100
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License Number State | NJ
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