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General NPI Number Information
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NPI Number | 1750351300
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Entity Type | Individual
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Provider Name | GANGADARSHNI CHANDRAMOHAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12021 WILMINGTON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90059-3019
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Country | US
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Telephone | 310-668-4653
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Fax | 310-668-8715
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Provider Business Mailing Address
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Address Line | 2320 CUMBERLAND RD
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City | SAN MARINO
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State | CA
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Zip | 91108-2105
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Country | US
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Telephone | 626-583-9161
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Fax | 626-432-4535
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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 | 2080P0210X
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Taxonomy Name | Pediatric Nephrology Physician
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License Number | A51443
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License Number State | CA
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