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General NPI Number Information
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NPI Number | 1093773277
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Entity Type | Organization
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Legal Business Name | ANNIE GOH DDS
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 25897 WESTERN AVE SUITE 2
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City | LOMITA
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State | CA
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Zip | 90717-3359
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Country | US
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Telephone | 310-530-0900
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Fax | 310-530-8508
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Provider Business Mailing Address
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Address Line | 25897 WESTERN AVE SUITE 2
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City | LOMITA
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State | CA
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Zip | 90717-3359
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Country | US
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Telephone | 310-530-0900
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Fax | 310-530-8508
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Authorized Official
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Title or Position | OWNER
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Name | ANNIE GOH
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Credential | D.D.S.
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Telephone | 310-530-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | B40937
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License Number State | CA
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