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General NPI Number Information
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NPI Number | 1689798472
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Entity Type | Individual
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Provider Name | JUNG S KIM M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2821 N BALLAS RD C-30
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2321
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Country | US
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Telephone | 314-567-7765
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Fax |
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Provider Business Mailing Address
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Address Line | 802 BLUESPRING LN
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2614
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Country | US
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Telephone | 314-432-0643
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | R7E16
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License Number State | MO
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