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General NPI Number Information
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NPI Number | 1043824212
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Entity Type | Organization
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Legal Business Name | MIDTOWN MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/03/2020
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 1267 N VIRGIL AVE
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City | LOS ANGELES
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State | CA
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Zip | 90029-2017
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Country | US
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Telephone | 323-664-7628
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Fax |
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Provider Business Mailing Address
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Address Line | 17215 STUDEBAKER RD STE 320
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City | CERRITOS
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State | CA
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Zip | 90703-2522
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Country | US
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Telephone | 760-941-7309
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RONALD SHIGEMATSU
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Credential | MD
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Telephone | 760-941-7309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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