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General NPI Number Information
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NPI Number | 1841511631
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Entity Type | Organization
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Legal Business Name | AMIN KHORSANDI MD INC
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Dates
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Enumeration Date | 06/16/2010
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | 2222 SANTA MONICA BLVD # 301
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City | SANTA MONICA
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State | CA
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Zip | 90404-2304
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Country | US
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Telephone | 310-449-0093
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Fax | 310-449-9204
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Provider Business Mailing Address
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Address Line | 2222 SANTA MONICA BLVD # 301
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City | SANTA MONICA
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State | CA
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Zip | 90404-2304
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Country | US
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Telephone | 310-449-0093
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Fax | 310-449-9204
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMIN KHORSANDI
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Credential | M.D.
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Telephone | 310-449-0093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A56357
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License Number State | CA
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