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General NPI Number Information
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NPI Number | 1720275217
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Entity Type | Individual
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Provider Name | ALI M KHOSROVANI DDS
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Gender | Male
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 4905 YORK BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90042-2022
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Country | US
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Telephone | 310-968-9192
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Fax | 310-575-9822
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Provider Business Mailing Address
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Address Line | 4905 YORK BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90042-1609
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Country | US
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Telephone | 323-255-8774
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Fax | 323-255-6259
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 56085
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 56085
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License Number State | CA
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