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General NPI Number Information
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NPI Number | 1700512662
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Entity Type | Organization
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Legal Business Name | JI SON
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 4445 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92501-4135
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Country | US
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Telephone | 951-268-7009
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Fax |
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Provider Business Mailing Address
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Address Line | 4445 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92501-4135
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Country | US
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Telephone | 951-268-7009
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | LINDA LONG
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Credential |
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Telephone | 501-223-2776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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