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General NPI Number Information
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NPI Number | 1114686250
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Entity Type | Individual
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Provider Name | RYAN KIM PTA
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Gender | Male
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Dates
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Enumeration Date | 12/16/2021
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 619 N FAIRFAX AVE
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City | LOS ANGELES
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State | CA
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Zip | 90036-1714
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Country | US
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Telephone | 886-884-5625
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Fax |
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Provider Business Mailing Address
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Address Line | 330 S BERENDO ST APT 229
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City | LOS ANGELES
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State | CA
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Zip | 90020-5800
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Country | US
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Telephone | 818-599-2534
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Fax |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PTA49299
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License Number State | CA
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