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General NPI Number Information
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NPI Number | 1629703509
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Entity Type | Organization
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Legal Business Name | KEVIN E. LEW, DDS, MD, PLLC
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Dates
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Enumeration Date | 07/23/2022
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 6701 RIALTO BLVD APT 2202
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City | AUSTIN
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State | TX
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Zip | 78735-8597
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Country | US
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Telephone | 512-828-3128
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Fax |
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Provider Business Mailing Address
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Address Line | 6705 W HIGHWAY 290 STE 502-273
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City | AUSTIN
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State | TX
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Zip | 78735-8400
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Country | US
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Telephone | 213-864-7670
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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. KEVIN EDWARD LEW
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Credential | DDS, MD
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Telephone | 213-864-7670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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