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General NPI Number Information
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NPI Number | 1811147531
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Entity Type | Organization
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Legal Business Name | KEYVAN ESMAEILI M D INC
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 03/27/2009
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Provider Practice Location Address
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Address Line | 215 S HICKORY ST STE 118
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City | ESCONDIDO
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State | CA
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Zip | 92025-4304
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Country | US
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Telephone | 714-373-0881
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1895
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City | ESCONDIDO
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State | CA
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Zip | 92033-1895
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Country | US
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Telephone | 714-373-0881
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEYVAN ESMAEILI
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Credential | MD
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Telephone | 714-373-0881
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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 | A72887
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License Number State | CA
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