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General NPI Number Information
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NPI Number | 1679649743
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Entity Type | Individual
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Provider Name | MOHAMMED WALID KHALIFE M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 06/06/2015
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Provider Practice Location Address
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Address Line | 1350 W COVINA BLVD
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City | SAN DIMAS
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State | CA
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Zip | 91773-3245
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Country | US
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Telephone | 909-599-6811
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Fax | 909-394-3367
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Provider Business Mailing Address
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Address Line | PO BOX 60790
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City | PASADENA
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State | CA
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Zip | 91116-6790
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Country | US
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Telephone | 626-795-6596
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Fax | 626-795-8247
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A31097
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License Number State | CA
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