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General NPI Number Information
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NPI Number | 1891815080
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Entity Type | Individual
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Provider Name | SAM KHOO P.A.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 476 E. WASHINGTON STREET
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City | EARLIMART
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State | CA
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Zip | 93219
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Country | US
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Telephone | 661-849-2638
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Fax | 661-849-5719
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Provider Business Mailing Address
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Address Line | PO BOX 790 650 ZEDIKER AVE.
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City | PARLIER
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State | CA
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Zip | 93648-0790
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Country | US
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Telephone | 559-646-6618
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Fax | 559-646-6614
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA13943
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License Number State | CA
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