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General NPI Number Information
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NPI Number | 1275820508
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Entity Type | Individual
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Provider Name | HEANG I LY O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/07/2011
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Last Update Date | 01/16/2017
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Provider Practice Location Address
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Address Line | 4767 WHITTIER BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-3027
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Country | US
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Telephone | 323-263-9173
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Fax |
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Provider Business Mailing Address
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Address Line | 7429 HELLMAN AVE
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City | ROSEMEAD
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State | CA
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Zip | 91770-2213
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Country | US
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Telephone | 626-236-6136
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 14195
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License Number State | CA
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