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General NPI Number Information
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NPI Number | 1689602583
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Entity Type | Individual
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Provider Name | BYUNG-BOONG LEE
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 1830 TOWN CENTER DR SUITE 420
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City | RESTON
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State | VA
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Zip | 20190-3292
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Country | US
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Telephone | 703-880-9500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 631856
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City | BALTIMORE
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State | MD
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Zip | 21263-1856
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Country | US
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Telephone |
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 0101023617
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License Number State | VA
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