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General NPI Number Information
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NPI Number | 1891877395
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Entity Type | Individual
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Provider Name | RYAN HIDEO AGENA MD
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Gender | Male
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3110 CHINO AVE STE 150A
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City | CHINO HILLS
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State | CA
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Zip | 91709-1295
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Country | US
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Telephone | 909-630-7490
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Fax | 909-469-2107
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Provider Business Mailing Address
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Address Line | 3110 CHINO AVE STE 150A
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City | CHINO HILLS
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State | CA
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Zip | 91709-1295
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Country | US
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Telephone | 909-630-7490
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Fax | 909-469-2108
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A9676
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License Number State | CA
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