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General NPI Number Information
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NPI Number | 1154412963
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Entity Type | Organization
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Legal Business Name | AUGUSTA U. IKHISEMOJIE, M.D., A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 6485 DAY ST STE 305
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City | RIVERSIDE
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State | CA
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Zip | 92507-0926
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Country | US
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Telephone | 951-413-6433
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Fax | 951-413-6633
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Provider Business Mailing Address
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Address Line | PO BOX 60790
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City | PASADENA
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State | CA
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Zip | 91116-6790
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Country | US
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Telephone | 626-795-6596
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Fax | 626-396-0851
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AUGUSTA UAYEMEN IKHISEMOJIE
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Credential | M.D.
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Telephone | 310-276-1688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A67133
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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 | A67133
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License Number State | CA
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