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General NPI Number Information
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NPI Number | 1689210825
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Entity Type | Organization
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Legal Business Name | MOYNIHAN FAMILY PRACTICE
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 11/22/2019
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Provider Practice Location Address
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Address Line | 6620 COYLE AVE STE 416
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City | CARMICHAEL
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State | CA
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Zip | 95608-6338
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Country | US
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Telephone | 530-400-4880
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 632
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City | DAVIS
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State | CA
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Zip | 95617-0632
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Country | US
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Telephone | 530-400-4880
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT/PHYSICIAN
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Name | DR. KEVIN M MOYNIHAN
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Credential | MD
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Telephone | 530-400-4880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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