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General NPI Number Information
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NPI Number | 1528426053
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Entity Type | Organization
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Legal Business Name | ALLERGY ASTHMA SINUSITIS MEDICAL CLINIC INC
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Dates
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Enumeration Date | 01/28/2016
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 11832 ROSECRANS AVE # 200
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City | NORWALK
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State | CA
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Zip | 90650-4107
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Country | US
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Telephone | 562-864-4500
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Fax | 562-864-4959
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Provider Business Mailing Address
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Address Line | 11832 ROSECRANS AVE # 200
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City | NORWALK
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State | CA
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Zip | 90650-4107
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Country | US
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Telephone | 562-864-4500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DIVYANG N TRIVEDI
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Credential | MD
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Telephone | 562-864-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | A42411
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License Number State | CA
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