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General NPI Number Information
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NPI Number | 1922209188
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Entity Type | Organization
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Legal Business Name | CASE WESTERN RESERVE UNIVERSITY
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10701 EAST BLVD K-216
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City | CLEVELAND
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State | OH
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Zip | 44106-1702
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Country | US
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Telephone | 216-791-3800
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Fax | 216-707-5972
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Provider Business Mailing Address
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Address Line | 1300 W 9TH ST APT 807
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City | CLEVELAND
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State | OH
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Zip | 44113-1031
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Country | US
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Telephone | 718-813-9422
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Fax | 216-707-5972
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Authorized Official
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Title or Position | FELLOW
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Name | DR. BRIAN BON-JEONG KOO
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Credential | M.D.
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Telephone | 216-791-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 35.087275
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License Number State | OH
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