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General NPI Number Information
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NPI Number | 1083079289
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Entity Type | Organization
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Legal Business Name | MAJESTIC MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 12/15/2015
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 817 ATLANTIC AVE # 14
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City | LONG BEACH
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State | CA
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Zip | 90813-4512
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Country | US
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Telephone | 562-453-5236
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Fax |
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Provider Business Mailing Address
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Address Line | 817 ATLANTIC AVE # 14
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City | LONG BEACH
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State | CA
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Zip | 90813-4512
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Country | US
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Telephone | 562-453-5236
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Fax |
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | DR. CHRISTINA DARY LEE
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Credential | M.D.
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Telephone | 562-453-5236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A62993
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License Number State | CA
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