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General NPI Number Information
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NPI Number | 1144596966
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Entity Type | Organization
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Legal Business Name | BENDITO PEDIATRICS INC
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 07/26/2012
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Provider Practice Location Address
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Address Line | 22030 SHERMAN WAY SUITE #210
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City | CANOGA PARK
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State | CA
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Zip | 91303-1855
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Country | US
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Telephone | 818-857-5991
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Fax | 818-703-0895
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Provider Business Mailing Address
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Address Line | 22030 SHERMAN WAY SUITE #210
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City | CANOGA PARK
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State | CA
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Zip | 91303-1855
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Country | US
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Telephone | 818-857-5991
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Fax | 818-703-0895
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Authorized Official
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Title or Position | CEO
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Name | DR. CHIOMA A KALU
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Credential | M.D.
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Telephone | 818-857-5991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A102218
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License Number State | CA
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