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General NPI Number Information
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NPI Number | 1316043698
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Entity Type | Individual
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Provider Name | KELLI A. CHASE M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 10 WOODLAND RD
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City | SAINT HELENA
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State | CA
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Zip | 94574-9554
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Country | US
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Telephone | 707-963-6288
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Fax | 310-698-7054
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Provider Business Mailing Address
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Address Line | 2374 E PACIFICA PL
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City | RANCHO DOMINGUEZ
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State | CA
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Zip | 90220-6214
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Country | US
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Telephone | 310-225-3244
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Fax | 310-698-7040
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | A69298
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License Number State | CA
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