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General NPI Number Information
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NPI Number | 1740285907
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Entity Type | Individual
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Provider Name | SAMUEL MO PARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 340 W EAST AVE
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City | CHICO
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State | CA
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Zip | 95926-7238
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Country | US
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Telephone | 530-342-2777
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Fax | 530-342-2776
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Provider Business Mailing Address
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Address Line | 236 W EAST AVE STE A PMB 253
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City | CHICO
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State | CA
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Zip | 95926-7236
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Country | US
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Telephone | 530-342-2777
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Fax | 530-342-2776
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 35076716P
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | G87601
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License Number State | CA
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