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General NPI Number Information
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NPI Number | 1598831083
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Entity Type | Individual
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Provider Name | POURANG JAHANSHAHI
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Gender | Male
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 12/26/2013
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Provider Practice Location Address
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Address Line | 39-05 61ST STREET, 2ND FLOOR
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City | WOODSIDE
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State | NY
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Zip | 11137
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Country | US
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Telephone | 917-279-7713
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Fax |
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Provider Business Mailing Address
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Address Line | 286 5TH AVE, APT 4E
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City | BROOKLYN
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State | NY
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Zip | 11215
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Country | US
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Telephone | 303-726-1699
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 053313-1
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License Number State | NY
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