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General NPI Number Information
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NPI Number | 1942924907
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Entity Type | Individual
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Provider Name | KACIE KLINE CONDON PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 420 E 3RD ST STE 805
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City | LOS ANGELES
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State | CA
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Zip | 90013-1646
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Country | US
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Telephone | 213-218-3915
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Fax |
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Provider Business Mailing Address
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Address Line | 1957 PORT CHELSEA PL
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5349
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Country | US
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Telephone | 949-922-1314
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Fax |
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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 | PA61679
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License Number State | CA
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