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General NPI Number Information
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NPI Number | 1366928855
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Entity Type | Individual
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Provider Name | ANGELA JEUNG DO
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Gender | Female
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 292 S 1470 E STE 200
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City | ST GEORGE
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State | UT
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Zip | 84790-1764
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Country | US
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Telephone | 435-688-0759
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 S SUNSET AVE
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City | WEST COVINA
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State | CA
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Zip | 91790-3940
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9268396
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 12749195-1204
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License Number State | UT
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