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General NPI Number Information
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NPI Number | 1427161173
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Entity Type | Individual
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Provider Name | KENNETH M. YAKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 3019 S. FREEWAY
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City | FORT WORTH
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State | TX
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Zip | 76104
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Country | US
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Telephone | 323-868-8099
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Fax | 815-550-1658
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Provider Business Mailing Address
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Address Line | PO BOX 445
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City | VENICE
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State | CA
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Zip | 90294-0445
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Country | US
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Telephone | 310-408-6357
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Fax | 213-365-2924
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G75747
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | P3488
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License Number State | TX
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