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General NPI Number Information
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NPI Number | 1932171519
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Entity Type | Individual
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Provider Name | NIPAVAN CHIAMVIMONVAT M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | VA MEDICAL CENTER 10535 HOSPITAL WAY
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City | MATHER
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State | CA
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Zip | 95655-1200
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Country | US
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Telephone | 916-843-7333
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Fax |
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Provider Business Mailing Address
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Address Line | 2622 ROCKWELL DR
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City | DAVIS
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State | CA
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Zip | 95616-7664
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Country | US
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Telephone | 530-752-0718
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Fax | 530-754-7167
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | G86340
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License Number State | CA
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