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General NPI Number Information
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NPI Number | 1205651106
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Entity Type | Individual
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Provider Name | SOHEIL REFOUA
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Gender | Male
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 8627 ATLANTIC AVE
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City | SOUTH GATE
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State | CA
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Zip | 90280-3501
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Country | US
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Telephone | 888-499-9303
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Fax |
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Provider Business Mailing Address
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Address Line | 2118 MALCOLM AVE
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City | LOS ANGELES
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State | CA
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Zip | 90025-6306
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Country | US
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Telephone | 310-746-7959
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS110420
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License Number State | CA
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