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General NPI Number Information
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NPI Number | 1871780296
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Entity Type | Individual
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Provider Name | DR. XIAODE MOU
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Gender | Female
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Dates
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Enumeration Date | 09/30/2007
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Last Update Date | 09/30/2007
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Provider Practice Location Address
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Address Line | 23 TECHNOLOGY DR SUITE 3
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City | EAST SETAUKET
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State | NY
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Zip | 11733-4075
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Country | US
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Telephone | 631-246-6461
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Fax | 631-246-6461
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Provider Business Mailing Address
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Address Line | 125 TERRYVILLE RD #1A
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1300
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Country | US
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Telephone | 917-648-6760
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 002038
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License Number State | NY
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