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General NPI Number Information
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NPI Number | 1871500363
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Entity Type | Individual
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Provider Name | DALJIT MAC M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 5014 CHESEBRO RD. 2ND FLOOR
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City | AGOURA HILLS
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State | CA
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Zip | 91301-4232
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Country | US
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Telephone | 818-706-9300
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Fax | 818-707-2672
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Provider Business Mailing Address
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Address Line | 5014 CHESEBRO RD. 2ND FLOOR
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City | AGOURA HILLS
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State | CA
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Zip | 91301-4232
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Country | US
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Telephone | 818-706-9300
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Fax | 818-707-2672
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C50502
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License Number State | CA
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