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General NPI Number Information
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NPI Number | 1770763690
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Entity Type | Organization
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Legal Business Name | SHAKOCAT INC.
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 07/02/2019
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Provider Practice Location Address
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Address Line | 124 N LA BREA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90036-2912
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Country | US
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Telephone | 818-922-2252
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Fax | 818-301-5156
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Provider Business Mailing Address
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Address Line | 11333 MOORPARK ST # 204
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City | STUDIO CITY
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State | CA
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Zip | 91602-2618
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Country | US
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Telephone |
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Fax | 818-301-5156
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Authorized Official
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Title or Position | REP
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Name | LEONID SATANOVSKY
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Credential |
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Telephone | 818-922-2252
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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 |
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License Number State |
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