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General NPI Number Information
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NPI Number | 1700555364
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Entity Type | Organization
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Legal Business Name | SPECIALTY CARE PAIN MEDICAL GROUP INC
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 11500 W OLYMPIC BLVD STE 502
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City | LOS ANGELES
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State | CA
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Zip | 90064-1528
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Country | US
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Telephone | 310-985-1779
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Fax | 626-609-4195
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Provider Business Mailing Address
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Address Line | 1653 7TH ST UNIT 7548
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City | SANTA MONICA
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State | CA
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Zip | 90406-8012
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Country | US
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Telephone | 310-564-6139
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Fax | 626-609-4195
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. BRIAN LAI
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Credential | MD
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Telephone | 310-985-1779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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