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General NPI Number Information
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NPI Number | 1073172896
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Entity Type | Individual
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Provider Name | MUHTADA ABDULELAH KAMAL ALDIN
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Gender | Male
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Dates
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Enumeration Date | 06/06/2019
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 4722 QUAIL LAKES DR STE B
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City | STOCKTON
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State | CA
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Zip | 95207-5256
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Country | US
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Telephone | 209-471-1848
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Fax | 209-472-0133
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Provider Business Mailing Address
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Address Line | PO BOX 255228
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City | SACRAMENTO
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State | CA
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Zip | 95865-5228
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Country | US
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Telephone | 800-470-0071
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Fax | 916-854-6769
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | A185612
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License Number State | CA
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