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General NPI Number Information
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NPI Number | 1811040843
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Entity Type | Individual
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Provider Name | MOHAMMAD NAMAZIAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/21/2007
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 11880 METROPOLITAN AVE APT 5F
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City | KEW GARDENS
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State | NY
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Zip | 11415-2063
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Country | US
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Telephone | 718-847-3635
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Fax | 718-847-3635
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Provider Business Mailing Address
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Address Line | 10950 CHURCH ST APT 2212
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-8081
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Country | US
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Telephone | 909-244-0550
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Fax | 909-244-0550
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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 | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 20A9672
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License Number State | CA
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