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General NPI Number Information
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NPI Number | 1770002511
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Entity Type | Individual
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Provider Name | JOO HYUNG KIM DDS
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Gender | Male
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 09/13/2017
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Provider Practice Location Address
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Address Line | 8035 W MANCHESTER AVE
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7985
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Country | US
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Telephone | 310-822-8118
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Fax |
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Provider Business Mailing Address
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Address Line | 456 S HARVARD BLVD APT 204
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City | LOS ANGELES
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State | CA
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Zip | 90020-3417
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Country | US
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Telephone | 213-595-1410
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DDS101622
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License Number State | CA
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