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General NPI Number Information
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NPI Number | 1619486552
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Entity Type | Individual
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Provider Name | KENMAKARA SOK
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Gender | Male
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Dates
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Enumeration Date | 09/22/2017
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Last Update Date | 09/22/2017
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Provider Practice Location Address
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Address Line | 4025 W FUQUA ST
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City | HOUSTON
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State | TX
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Zip | 77045-6303
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Country | US
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Telephone | 800-298-3948
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Fax | 888-331-4002
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Provider Business Mailing Address
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Address Line | 2731 SKYVIEW POINT DR
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City | HOUSTON
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State | TX
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Zip | 77047-8123
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Country | US
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Telephone | 832-274-3059
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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