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General NPI Number Information
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NPI Number | 1396892972
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Entity Type | Individual
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Provider Name | MILES KEN MASATSUGU M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 04/01/2010
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Provider Practice Location Address
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Address Line | 420 S GLENDORA AVE
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City | WEST COVINA
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State | CA
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Zip | 91790-3001
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Country | US
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Telephone | 626-919-4333
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Fax |
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Provider Business Mailing Address
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Address Line | 3378 CORTE CASSIS
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City | COSTA MESA
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State | CA
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Zip | 92626-1667
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Country | US
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Telephone | 626-347-0232
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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 | A070325
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License Number State | CA
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