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General NPI Number Information
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NPI Number | 1487657029
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Entity Type | Individual
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Provider Name | DOMINIC E. B. KOH CPNP, ANP-C
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Gender | Male
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 07/06/2010
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Provider Practice Location Address
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Address Line | 1530 HILLHURST AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027-5516
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Country | US
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Telephone | 323-644-3880
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Fax | 323-644-3892
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Provider Business Mailing Address
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Address Line | 2571 ROCHELLE AVE
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City | MONROVIA
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State | CA
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Zip | 91016-4941
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Country | US
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Telephone | 626-303-3950
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN476192, NPF 8506
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | RN476192, NPF 8506
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License Number State | CA
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