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General NPI Number Information
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NPI Number | 1225852403
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Entity Type | Organization
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Legal Business Name | DEXAMONITOR
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 27965 SMYTH DR
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City | VALENCIA
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State | CA
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Zip | 91355-6016
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Country | US
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Telephone | 661-200-3024
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Fax |
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Provider Business Mailing Address
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Address Line | 23845 RIO RANCH WAY
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City | VALENCIA
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State | CA
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Zip | 91354-1584
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Country | US
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Telephone | 310-866-8279
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | KELLY SOONG
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Credential |
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Telephone | 310-866-8279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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