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General NPI Number Information
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NPI Number | 1831765767
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Entity Type | Individual
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Provider Name | KYLE RAYMOND MOW DMD
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Gender | Male
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Dates
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Enumeration Date | 06/01/2021
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 2413 PACIFIC COAST HWY
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City | LOMITA
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State | CA
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Zip | 90717-2395
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Country | US
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Telephone | 310-326-3944
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Fax |
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Provider Business Mailing Address
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Address Line | 12664 LIDDINGTON ST
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City | CERRITOS
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State | CA
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Zip | 90703-7225
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Country | US
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Telephone | 916-601-1197
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 106184
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License Number State | CA
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