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General NPI Number Information
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NPI Number | 1821375965
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Entity Type | Organization
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Legal Business Name | SOUTHBAY FAMILY MEDICAL CLINIC
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Dates
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Enumeration Date | 11/03/2011
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Last Update Date | 11/03/2011
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Provider Practice Location Address
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Address Line | 23517 MAIN ST SUITE # 103
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City | CARSON
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State | CA
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Zip | 90745-5251
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Country | US
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Telephone | 310-834-5388
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Fax |
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Provider Business Mailing Address
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Address Line | 23517 S MAIN ST. SUITE # 103
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City | CARSON
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State | CA
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Zip | 90745
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SHRIKANT TAMHANE
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Credential | M.D.
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Telephone | 310-834-5388
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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 | 19910
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License Number State | CA
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