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General NPI Number Information
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NPI Number | 1366520199
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Entity Type | Individual
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Provider Name | MING FANG MD
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 675 YGNACIO VALLEY RD SUITE 215
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City | WALNUT CREEK
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State | CA
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Zip | 94596-3860
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Country | US
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Telephone | 925-776-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 2036 SORRELWOOD CT
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City | SAN RAMON
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State | CA
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Zip | 94582-5004
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Country | US
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Telephone |
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A83531
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License Number State | CA
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