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General NPI Number Information
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NPI Number | 1992962344
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Entity Type | Organization
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Legal Business Name | MMK HEALTH CARE, A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 01/03/2009
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Provider Practice Location Address
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Address Line | 6327 RIGGS PL
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City | LOS ANGELES
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State | CA
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Zip | 90045-1239
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Country | US
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Telephone | 818-419-0049
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Fax | 310-337-9459
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Provider Business Mailing Address
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Address Line | PO BOX 45228
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City | LOS ANGELES
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State | CA
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Zip | 90045-0221
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Country | US
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Telephone | 818-419-0049
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Fax | 310-337-9459
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL M. KOSHAK
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Credential | M.D.
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Telephone | 818-419-0049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A36588
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License Number State | CA
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