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General NPI Number Information
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NPI Number | 1295882496
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Entity Type | Individual
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Provider Name | SERGE OBUKHOFF M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6200 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90048-5801
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Country | US
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Telephone | 323-933-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 27159 SEA VISTA DR
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City | MALIBU
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State | CA
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Zip | 90265-4436
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Country | US
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Telephone | 310-457-7421
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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 | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | B65490
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License Number State | CA
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