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General NPI Number Information
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NPI Number | 1811347024
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Entity Type | Individual
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Provider Name | SUSAN KU D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/18/2016
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 3901 MAIN ST STE 211
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City | FLUSHING
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State | NY
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Zip | 11354-5435
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Country | US
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Telephone | 718-762-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 3580 LOUIS RD
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City | PALO ALTO
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State | CA
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Zip | 94303-4405
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Country | US
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Telephone | 650-283-0502
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 059630
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 107282
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License Number State | CA
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