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General NPI Number Information
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NPI Number | 1700767944
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Entity Type | Individual
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Provider Name | LEITHA HAKANSON
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Gender | Female
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Dates
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Enumeration Date | 09/11/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 625 W COLLEGE ST STE 105
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City | LOS ANGELES
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State | CA
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Zip | 90012-1650
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Country | US
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Telephone | 213-265-7433
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Fax | 213-265-7531
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Provider Business Mailing Address
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Address Line | 17343 BURMA ST
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City | ENCINO
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State | CA
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Zip | 91316-1334
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Country | US
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Telephone | 818-486-9075
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 13840
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License Number State | CA
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