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General NPI Number Information
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NPI Number | 1831384981
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Entity Type | Organization
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Legal Business Name | VALLEY CARE MEDICAL GROUP, INC
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 09/14/2007
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Provider Practice Location Address
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Address Line | 777 HAWKEYE AVE SUITE 3
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City | TURKLOCK
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State | CA
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Zip | 95380
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Country | US
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Telephone | 209-667-1718
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Fax |
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Provider Business Mailing Address
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Address Line | 4021 THORNHILL WAY
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City | MODESTO
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State | CA
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Zip | 95356-9351
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Country | US
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Telephone | 209-241-6309
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SUSAN PHI LE
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Credential | MD
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Telephone | 209-241-6309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A89810
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License Number State | CA
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