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General NPI Number Information
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NPI Number | 1366653354
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Entity Type | Individual
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Provider Name | VIMAL J PONNEZHAN MD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 4081 E OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90023-3330
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Country | US
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Telephone | 323-267-0477
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Fax |
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Provider Business Mailing Address
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Address Line | 3579 E FOOTHILL BLVD STE 432
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City | PASADENA
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State | CA
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Zip | 91107-3119
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Country | US
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Telephone | 310-422-3000
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301087977
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | A116214
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License Number State | CA
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