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General NPI Number Information
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NPI Number | 1790850279
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Entity Type | Organization
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Legal Business Name | PEDIATRIC SUBSPECIALTY FACULTY, INC.
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1201 W LA VETA AVE
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City | ORANGE
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State | CA
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Zip | 92868-4203
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Country | US
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Telephone | 714-509-8649
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Fax | 714-509-8374
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Provider Business Mailing Address
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Address Line | 455 S MAIN ST
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City | ORANGE
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State | CA
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Zip | 92868-3835
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Country | US
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Telephone | 715-094-8649
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Fax | 714-509-8374
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. HALE KUHLMAN
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Credential |
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Telephone | 714-532-8649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | CA
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