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General NPI Number Information
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NPI Number | 1609048867
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Entity Type | Organization
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Legal Business Name | KEVIN E. LEW, DDS, MD, INC.
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 321 N LARCHMONT BLVD SUITE 617
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City | LOS ANGELES
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State | CA
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Zip | 90004-3025
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Country | US
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Telephone | 323-465-6451
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Fax | 323-465-6446
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Provider Business Mailing Address
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Address Line | 321 N LARCHMONT BLVD SUITE 617
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City | LOS ANGELES
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State | CA
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Zip | 90004-3025
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Country | US
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Telephone | 323-465-6451
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Fax | 323-465-6446
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN EDWARD LEW
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Credential | DDS, MD
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Telephone | 323-465-6451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 48634
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License Number State | CA
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