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General NPI Number Information
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NPI Number | 1174026926
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Entity Type | Organization
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Legal Business Name | EDMUND H. LEW, MD, INC
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 03/16/2018
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Provider Practice Location Address
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Address Line | 1505 WILSON TER STE 250
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City | GLENDALE
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State | CA
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Zip | 91206-4075
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Country | US
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Telephone | 818-246-7115
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Fax | 818-246-8352
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Provider Business Mailing Address
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Address Line | 1505 WILSON TER STE 250
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City | GLENDALE
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State | CA
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Zip | 91206-4075
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Country | US
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Telephone | 818-246-7115
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Fax | 818-246-8352
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Authorized Official
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Title or Position | OWNER
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Name | EDMUND H LEW
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Credential | MD
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Telephone | 818-246-7115
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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 | G55213
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License Number State | CA
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