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General NPI Number Information
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NPI Number | 1881131589
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Entity Type | Organization
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Legal Business Name | LAURI I. AN
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 2655 W OLYMPIC BLVD SUITE 207
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City | LOS ANGELES
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State | CA
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Zip | 90006-2800
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Country | US
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Telephone | 213-388-7887
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Fax | 213-388-3504
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Provider Business Mailing Address
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Address Line | 2655 W OLYMPIC BLVD SUITE 207
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City | LOS ANGELES
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State | CA
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Zip | 90006-2800
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Country | US
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Telephone | 213-388-7887
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Fax | 213-388-3504
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. LAURI I AN
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Credential | M.D.
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Telephone | 213-388-7887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A42565
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License Number State | CA
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