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General NPI Number Information
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NPI Number | 1811070964
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Entity Type | Organization
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Legal Business Name | EYESTHESTICA
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 800 FAIRMOUNT AVE SUITE 207
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City | PASADENA
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State | CA
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Zip | 91105-3150
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Country | US
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Telephone | 310-360-3922
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Fax | 310-360-9246
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Provider Business Mailing Address
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Address Line | PO BOX 50187
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City | PASADENA
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State | CA
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Zip | 91115-0187
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Country | US
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Telephone | 310-360-3922
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Fax | 310-360-9246
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MS. VALERIE KWAN
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Credential |
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Telephone | 310-360-3922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | AAAHC
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License Number State | CA
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