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General NPI Number Information
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NPI Number | 1700339504
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Entity Type | Individual
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Provider Name | RAHUL NIKAM MBBS
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Gender | Male
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Dates
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Enumeration Date | 07/27/2016
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 1201 W LA VETA AVE
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City | ORANGE
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State | CA
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Zip | 92868-4203
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Country | US
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Telephone | 888-483-5670
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Fax | 844-890-2297
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Provider Business Mailing Address
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Address Line | 1201 W LA VETA AVE
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City | ORANGE
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State | CA
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Zip | 92868-4203
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Country | US
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Telephone | 888-483-5670
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Fax | 844-890-2297
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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 | 2085D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Radiology) Physician
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License Number | MT210275
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | C195551
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | C1-0012542
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License Number State | DE
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