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Individual

MR. MARK WAKABAYASHI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1500 E DUARTE RD, DUARTE, CA 91010
(626) 256-4673
Mailing address
PO BOX 512185, LOS ANGELES, CA 90051-0185
(626) 775-3514
(626) 218-5310

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
A71305
CA
207VX0201X
Gynecologic Oncology Physician
Primary
A71305
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00A713050
CA
Enumeration date
10/04/2006
Last updated
03/26/2018
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