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General NPI Number Information
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NPI Number | 1780086397
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Entity Type | Organization
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Legal Business Name | KOH MEDICAL INC
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 01/17/2015
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Provider Practice Location Address
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Address Line | 350 HAWTHORNE AVE
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City | OAKLAND
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State | CA
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Zip | 94609-3108
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Country | US
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Telephone | 510-213-1154
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Fax |
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Provider Business Mailing Address
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Address Line | 43523 PUESTA DEL SOL
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City | FREMONT
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State | CA
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Zip | 94539-5634
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Country | US
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Telephone | 510-213-1154
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HENRY KOH
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Credential | M.D.
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Telephone | 510-213-1154
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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 | A117951
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License Number State | CA
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