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General NPI Number Information
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NPI Number | 1063991685
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Entity Type | Organization
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Legal Business Name | REVIVE PAIN & SPINE CENTER INC
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 3609 MISSION AVE STE D
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City | CARMICHAEL
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State | CA
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Zip | 95608-2955
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Country | US
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Telephone | 530-650-8333
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Fax | 530-650-8388
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Provider Business Mailing Address
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Address Line | 255 W COURT ST STE D
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City | WOODLAND
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State | CA
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Zip | 95695-2986
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Country | US
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Telephone | 530-650-8333
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Fax | 530-650-8388
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | DR. AKBAR KHAN
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Credential | DO
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Telephone | 530-650-8333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 20A13486
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License Number State | CA
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