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Individual

STANLEY SOOYOUN KIM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
609 HAZELTON ST, MARICOPA, CA 93252
(661) 416-4096
Mailing address
609 HAZELTON ST, MARICOPA, CA 93252
(661) 416-4096

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
D5481793
CA

Other

Enumeration date
03/06/2018
Last updated
03/06/2018
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