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General NPI Number Information
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NPI Number | 1710624465
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Entity Type | Individual
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Provider Name | MONY PHEACHNAK SON D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/15/2022
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 18460 ROSCOE BLVD FL 3
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4107
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Country | US
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Telephone | 818-885-5480
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Fax | 818-993-1917
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Provider Business Mailing Address
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Address Line | 3400 DATA DR ATTENTION: CREDENTIALING AND PAYER ENROLLMENT DEPT
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670
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Country | US
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Telephone |
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | A21867
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License Number State | CA
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