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General NPI Number Information
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NPI Number | 1407161326
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Entity Type | Organization
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Legal Business Name | FOUNTAIN VALLEY HOSPITALIST MEDICAL GROUP
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 11770 WARNER AVE SUITE# 208
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-2663
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Country | US
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Telephone | 714-436-0111
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Fax |
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Provider Business Mailing Address
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Address Line | 2924 ALTA VISTA DR
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-3205
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Country | US
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Telephone | 714-545-5501
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. JIN-JOU LU
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Credential | M.D.
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Telephone | 714-545-5501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | A41229
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License Number State | CA
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