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General NPI Number Information
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NPI Number | 1619039815
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Entity Type | Organization
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Legal Business Name | CLOVE LAKES ENT PC
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 02/25/2021
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Provider Practice Location Address
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Address Line | 1414 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10301
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Country | US
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Telephone | 718-447-1261
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Fax | 718-981-1856
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Provider Business Mailing Address
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Address Line | 1414 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10301
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Country | US
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Telephone | 718-447-1261
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Fax | 718-981-1856
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Authorized Official
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Title or Position | OWNER
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Name | DR. HELEN HYOSUN KIM
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Credential | MD
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Telephone | 917-596-7063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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