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General NPI Number Information
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NPI Number | 1497138499
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Entity Type | Individual
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Provider Name | SHYAM SASIDHARAN KOLANGARA MD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2015
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 1250 LA VENTA DR STE 207
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-3766
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Country | US
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Telephone | 805-494-6920
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Fax | 805-494-6922
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD STE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A184725
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | A184725
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License Number State | CA
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