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General NPI Number Information
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NPI Number | 1992126759
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Entity Type | Organization
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Legal Business Name | B.M.E MEDICAL GROUP
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Dates
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Enumeration Date | 12/20/2013
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Last Update Date | 12/20/2013
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Provider Practice Location Address
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Address Line | 2100 FOOTHILL BLVD STE A
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City | LA VERNE
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State | CA
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Zip | 91750-2905
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Country | US
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Telephone | 909-593-8682
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Fax |
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Provider Business Mailing Address
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Address Line | 4912 BARSTOW ST
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City | LOS ANGELES
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State | CA
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Zip | 90032-2110
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Country | US
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Telephone | 760-383-1168
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. WEIKUANG LEE
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Credential | L.AC
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Telephone | 760-383-1168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | AC13579
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License Number State | CA
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