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General NPI Number Information
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NPI Number | 1801826797
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Entity Type | Individual
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Provider Name | SUDHA MANJUNATH M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 05/13/2013
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Provider Practice Location Address
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Address Line | 3300 CAPITOL AVE
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City | FREMONT
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State | CA
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Zip | 94538-1514
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Country | US
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Telephone | 510-574-2050
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Fax |
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Provider Business Mailing Address
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Address Line | 41563 DENISE ST
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City | FREMONT
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State | CA
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Zip | 94539-4561
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Country | US
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Telephone | 510-284-9584
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Fax |
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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 | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | A87131
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A87131
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License Number State | CA
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