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General NPI Number Information
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NPI Number | 1669553954
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Entity Type | Individual
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Provider Name | SHAO-POW LIN M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 01/11/2013
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Provider Practice Location Address
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Address Line | 4101 WAGON TRAIL AVE
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City | LAS VEGAS
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State | NV
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Zip | 89118-4426
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Country | US
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Telephone | 702-942-4123
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Fax | 702-942-4124
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Provider Business Mailing Address
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Address Line | 1 INDEPENDENCE PT STE 202
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City | GREENVILLE
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State | SC
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Zip | 29615-4536
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Country | US
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Telephone | 877-406-2916
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2002013710
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 13082
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License Number State | NV
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