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General NPI Number Information
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NPI Number | 1104958784
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Entity Type | Organization
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Legal Business Name | KUSH MEDICAL GROUP
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Dates
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Enumeration Date | 03/10/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 14015 VAN NESS AVE # 10
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City | GARDENA
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State | CA
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Zip | 90249-2937
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Country | US
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Telephone | 310-327-7682
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Fax | 310-327-7765
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Provider Business Mailing Address
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Address Line | PO BOX 6299
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City | TORRANCE
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State | CA
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Zip | 90504-0299
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Country | US
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Telephone | 310-327-7682
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Fax | 310-327-7765
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Authorized Official
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Title or Position | OWNER
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Name | DR. KIANSI BONI
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Credential | MD
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Telephone | 310-644-3488
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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 | A45536
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A45536
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | A45536
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | A45536
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License Number State | CA
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