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General NPI Number Information
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NPI Number | 1417210683
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Entity Type | Organization
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Legal Business Name | PAIN CENTER
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 817 W 17TH ST
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City | SANTA ANA
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State | CA
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Zip | 92706-3624
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Country | US
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Telephone | 714-969-8287
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Fax | 714-908-7793
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Provider Business Mailing Address
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Address Line | 6548 ASHBURY CIR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-6635
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Country | US
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Telephone | 714-991-7246
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Fax | 714-908-7793
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY E LYNCH
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Credential | MD
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Telephone | 714-991-7346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | G74208
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License Number State | CA
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