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General NPI Number Information
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NPI Number | 1316042161
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Entity Type | Organization
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Legal Business Name | ALLERGY AND ASTHMA CENTER MEDICAL GROUP INC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 11645 WILSHIRE BLVD STE 988
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City | LOS ANGELES
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State | CA
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Zip | 90025-6809
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Country | US
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Telephone | 310-820-1561
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Fax | 310-826-0895
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Provider Business Mailing Address
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Address Line | 11645 WILSHIRE BLVD STE 988
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City | LOS ANGELES
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State | CA
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Zip | 90025-6809
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Country | US
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Telephone | 310-820-1561
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Fax | 310-826-0895
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Authorized Official
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Title or Position | MEDICAL DOCTOR PHYSICIAN
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Name | DR. LAWRENCE S MIHALAS
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Credential | MD
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Telephone | 310-820-1561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | G29836
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License Number State | CA
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