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General NPI Number Information
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NPI Number | 1760917819
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Entity Type | Organization
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Legal Business Name | CY-SAGE MEDICAL CLINIC
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 16506 FM 529 RD STE 116
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City | HOUSTON
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State | TX
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Zip | 77095
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Country | US
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Telephone | 281-815-3812
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Fax | 281-815-3812
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Provider Business Mailing Address
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Address Line | PO BOX 1239
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City | CYPRESS
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State | TX
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Zip | 77410-1239
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Country | US
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Telephone | 281-815-3812
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Fax | 833-217-0891
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. KHADIJAT OGUNBIYI
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Credential | M.D.
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Telephone | 832-368-0596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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