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General NPI Number Information
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NPI Number | 1437495462
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Entity Type | Organization
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Legal Business Name | FLORENCE WESTERN MEDICAL CLINIC, INC
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Dates
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Enumeration Date | 12/19/2012
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 20440 SHERMAN WAY
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City | CANOGA PARK
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State | CA
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Zip | 91306-3110
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Country | US
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Telephone | 818-346-2395
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Fax | 818-346-4591
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Provider Business Mailing Address
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Address Line | 7301 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90047-2254
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Country | US
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Telephone | 818-346-2395
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Fax | 818-346-4591
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN CHARLES THOMAS
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Credential | MD
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Telephone | 323-778-2131
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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 | A52385
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License Number State | CA
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