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General NPI Number Information
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NPI Number | 1972086684
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Entity Type | Individual
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Provider Name | STEVEN KYONGMIN KIM DMD
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Gender | Male
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Dates
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Enumeration Date | 09/09/2018
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Last Update Date | 07/07/2020
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Provider Practice Location Address
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Address Line | 209 E 56TH ST FRNT 1
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City | NEW YORK
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State | NY
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Zip | 10022
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Country | US
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Telephone | 212-355-2295
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Fax |
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Provider Business Mailing Address
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Address Line | 301 W 53RD ST APT 5G
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City | NEW YORK
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State | NY
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Zip | 10019-5768
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Country | US
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Telephone | 847-414-6911
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 060478
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 22DI02695100
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License Number State | NJ
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