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General NPI Number Information
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NPI Number | 1861138505
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Entity Type | Organization
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Legal Business Name | KOOKOOTSEDES MEDICAL PC
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Dates
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Enumeration Date | 05/06/2022
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 25411 CABOT RD STE 109
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-5517
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Country | US
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Telephone | 949-535-4001
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Fax |
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Provider Business Mailing Address
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Address Line | 25411 CABOT RD STE 109
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-5517
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Country | US
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Telephone | 949-535-4001
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Fax | 949-535-4002
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Authorized Official
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Title or Position | MD
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Name | GAYLE KOOKOOTSEDES
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Credential |
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Telephone | 949-535-4001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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