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General NPI Number Information
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NPI Number | 1962568840
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Entity Type | Individual
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Provider Name | KELLY THOMAS WOYEWODZIC M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 10323 SANTA MONICA BLVD. SUITE 101
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City | LOS ANGELES
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State | CA
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Zip | 90025
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Country | US
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Telephone | 310-499-1350
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Fax | 310-360-0868
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Provider Business Mailing Address
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Address Line | 10323 SANTA MONICA BLVD. SUITE 101
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City | LOS ANGELES
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State | CA
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Zip | 90025
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Country | US
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Telephone | 310-499-1350
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Fax | 310-360-0868
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 229504
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A92740
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 92740
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License Number State | CA
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