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General NPI Number Information
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NPI Number | 1992140495
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Entity Type | Organization
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Legal Business Name | SM MED CORP
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Dates
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Enumeration Date | 05/09/2013
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Last Update Date | 05/09/2013
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Provider Practice Location Address
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Address Line | 16530 VENTURA BLVD STE 100
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City | ENCINO
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State | CA
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Zip | 91436-2006
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Country | US
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Telephone | 818-465-6614
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 260920
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City | ENCINO
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State | CA
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Zip | 91426-0920
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMIR S MAKOUI
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Credential |
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Telephone | 818-465-6614
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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 | A75531
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License Number State | CA
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