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General NPI Number Information
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NPI Number | 1366680639
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Entity Type | Organization
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Legal Business Name | KAISER PERMANENTE
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Dates
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Enumeration Date | 01/26/2009
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Last Update Date | 01/26/2009
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Provider Practice Location Address
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Address Line | 25825 SOUTH VERMONT AVE.
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City | HARBOR CITY
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State | CA
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Zip | 90710
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Country | US
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Telephone | 310-517-4060
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Fax |
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Provider Business Mailing Address
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Address Line | 1708 ESPLANADE APT 10
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City | REDONDO BEACH
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State | CA
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Zip | 90277-5326
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Country | US
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Telephone | 310-913-3969
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. SARAH NINNESS-SEVERIOS
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Credential | D.P.T.
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Telephone | 310-913-3969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 35342
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 35342
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License Number State | CA
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