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General NPI Number Information
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NPI Number | 1588158026
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Entity Type | Organization
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Legal Business Name | FOOT HEEL ANKLE PODIATRY CORPORATION
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Dates
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Enumeration Date | 06/19/2018
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Last Update Date | 06/23/2018
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Provider Practice Location Address
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Address Line | 1520 N MOUNTAIN AVE # E122
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City | ONTARIO
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State | CA
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Zip | 91762
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Country | US
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Telephone | 714-696-8746
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Fax |
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Provider Business Mailing Address
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Address Line | 1850 S AZUSA AVE STE 306
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745-6854
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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 | PRESIDENT
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Name | BRIAN WONG
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Credential | DPM
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Telephone | 714-747-4126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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