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General NPI Number Information
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NPI Number | 1255071635
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Entity Type | Organization
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Legal Business Name | ALLERGY & IMMUNOLOGY CENTER INC
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Dates
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Enumeration Date | 04/01/2022
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 16661 VENTURA BLVD STE 311
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City | ENCINO
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State | CA
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Zip | 91436-1955
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Country | US
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Telephone | 310-867-3480
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Fax |
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Provider Business Mailing Address
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Address Line | 5333 VELOZ AVE
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City | TARZANA
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State | CA
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Zip | 91356-4127
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Country | US
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Telephone | 310-867-3480
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. RYAN SHILIAN
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Credential | DO
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Telephone | 310-867-3480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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