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General NPI Number Information
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NPI Number | 1902003791
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Entity Type | Organization
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Legal Business Name | SOUTH COAST FAMILY MEDICAL CENTER INC
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 25500 RANCHO NIGUEL RD STE 100
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-7373
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Country | US
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Telephone | 949-643-8921
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Fax | 949-643-3914
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Provider Business Mailing Address
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Address Line | 25500 RANCHO NIGUEL RD STE 100
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-7373
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Country | US
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Telephone | 949-643-8921
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Fax | 949-643-3914
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL ALAN KENT
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Credential | M.D.,
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Telephone | 949-643-8921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A37009
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License Number State | CA
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