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General NPI Number Information
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NPI Number | 1043836778
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Entity Type | Individual
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Provider Name | ALI KHAVARI DPM
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Gender | Male
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Dates
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Enumeration Date | 06/18/2020
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 2637 SHADELANDS DR
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City | WALNUT CREEK
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State | CA
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Zip | 94598-2512
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Country | US
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Telephone | 925-464-1982
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Fax |
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Provider Business Mailing Address
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Address Line | 2637 SHADELANDS DR
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City | WALNUT CREEK
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State | CA
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Zip | 94598-2512
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Country | US
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Telephone | 925-464-1982
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E6047
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License Number State | CA
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