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General NPI Number Information
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NPI Number | 1053131797
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Entity Type | Organization
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Legal Business Name | LOS ANGELES HEMATOLOGY ONCOLOGY MEDICAL GROUP
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 4500 BROCKTON AVE STE 107
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City | RIVERSIDE
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State | CA
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Zip | 92501-4006
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Country | US
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Telephone | 951-276-2760
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Fax |
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Provider Business Mailing Address
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Address Line | 541 W COLORADO ST STE 205
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City | GLENDALE
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State | CA
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Zip | 91204-3640
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BORIS BAGDASARIAN
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Credential |
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Telephone | 818-409-0105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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