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General NPI Number Information
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NPI Number | 1497635221
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Entity Type | Organization
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Legal Business Name | LIPOV MEDICAL GROUP OF CA PC
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 12381 WILSHIRE BLVD STE 205
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City | LOS ANGELES
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State | CA
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Zip | 90025-1063
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Country | US
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Telephone | 855-519-2122
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Fax |
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Provider Business Mailing Address
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Address Line | 1 E OAKHILL DR STE 100
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City | WESTMONT
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State | IL
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Zip | 60559-5540
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Country | US
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Telephone | 855-519-2122
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. EUGENE LIPOV
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Credential | MD
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Telephone | 312-618-0829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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