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General NPI Number Information
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NPI Number | 1518587906
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Entity Type | Individual
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Provider Name | DONG-RU HO MD
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Gender | Male
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Dates
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Enumeration Date | 04/25/2020
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Last Update Date | 04/25/2020
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Provider Practice Location Address
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Address Line | 13015 EVENING CREEK DR S UNIT 17
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City | SAN DIEGO
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State | CA
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Zip | 92128-8114
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Country | US
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Telephone | 919-457-7577
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Fax |
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Provider Business Mailing Address
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Address Line | 11923 NE SUMNER ST STE 720534
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City | PORTLAND
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State | OR
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Zip | 97250-9601
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Country | US
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Telephone | 415-857-3127
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 00867019
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License Number State |
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