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General NPI Number Information
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NPI Number | 1477654341
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Entity Type | Organization
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Legal Business Name | KELLY MAH, M.D.
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 421 E CENTER ST
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City | MANTECA
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State | CA
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Zip | 95336-4718
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Country | US
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Telephone | 209-823-7616
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Fax | 209-823-4352
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Provider Business Mailing Address
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Address Line | 421 E CENTER ST
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City | MANTECA
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State | CA
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Zip | 95336-4718
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Country | US
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Telephone | 209-823-7616
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Fax | 209-823-4352
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Authorized Official
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Title or Position | PRESIDENT
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Name | KELLY MAH
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Credential | M.D.
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Telephone | 209-823-7616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G065156
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License Number State | CA
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