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1326206301 NPI number — MANJU CHACKO DAWKINS M.D.

NPI Number: 1326206301
Health Care Provider/Practitioner: MANJU CHACKO DAWKINS M.D.

Information about “1326206301” NPI (MANJU CHACKO DAWKINS M.D.) exists in 1326206301 in HTML format HTML  |  1326206301 in plain Text format TXT  |  1326206301 in PDF (Portable Document Format) PDF  |  1326206301 in an XML format XML  formats.

NPI Number : 1326206301 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1326206301",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DAWKINS",
    "FirstName": "MANJU",
    "MiddleName": "CHACKO",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CHACKO",
    "OtherFirstName": "MANJU",
    "OtherMiddleName": "TRACY",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "M.D.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "5971 VENICE BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOS ANGELES",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90034-1713",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "323-857-4322",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5971 VENICE BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOS ANGELES",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90034-1713",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "323-857-4322",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/27/2008",
    "LastUpdateDate": "04/13/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207N00000X",
          "TaxonomyName": "Dermatology Physician",
          "LicenseNumber": "246191-1",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207N00000X",
          "TaxonomyName": "Dermatology Physician",
          "LicenseNumber": "A121539",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "207N00000X",
          "TaxonomyName": "Dermatology Physician",
          "LicenseNumber": "FD2807052",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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