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General NPI Number Information
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NPI Number | 1710262571
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Entity Type | Organization
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Legal Business Name | JAMAL HUSSAIN MD INC
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Dates
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Enumeration Date | 10/12/2011
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Last Update Date | 03/04/2017
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Provider Practice Location Address
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Address Line | 3650 SOUTH ST STE 105
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City | LAKEWOOD
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State | CA
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Zip | 90712-1502
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Country | US
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Telephone | 562-630-7711
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3939
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City | LAKEWOOD
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State | CA
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Zip | 90711-3939
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Country | US
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Telephone | 562-630-7711
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMAL HUSSAIN
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Credential | MD
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Telephone | 562-630-7711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | C52498
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License Number State | CA
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