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General NPI Number Information
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NPI Number | 1497076780
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Entity Type | Organization
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Legal Business Name | ADVANCED SPECIALTY ANESTHESIA & PAIN MANAGEMENT, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 06/21/2010
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Last Update Date | 08/07/2012
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Provider Practice Location Address
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Address Line | 219 W 7TH ST 207
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City | LOS ANGELES
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State | CA
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Zip | 90014-1950
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Country | US
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Telephone | 310-310-5817
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Fax | 310-496-0183
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Provider Business Mailing Address
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Address Line | 219 W 7TH ST 207
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City | LOS ANGELES
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State | CA
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Zip | 90014-1950
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Country | US
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Telephone | 310-310-5817
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Fax | 310-496-0183
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL SHIN
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Credential | MD
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Telephone | 310-310-5817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | G75155
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License Number State | CA
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