{
"Npi": {
"NPI": "1013082783",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SERRAND MEDICAL CENTER PHARMACY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4220 WEST 3RD ST",
"SecondLineMailingAddress": "SUITE #100",
"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90020",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "213-381-3855",
"MailingAddressFaxNumber": "213-381-3856",
"FirstLinePracticeLocationAddress": "4220 WEST 3RD ST",
"SecondLinePracticeLocationAddress": "SUITE #100",
"PracticeLocationAddressCityName": "LOS ANGELES",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90020",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "213-381-3855",
"PracticeLocationAddressFaxNumber": "213-381-3856",
"EnumerationDate": "11/21/2006",
"LastUpdateDate": "03/07/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PARK",
"AuthorizedOfficialFirstName": "CHANG",
"AuthorizedOfficialMiddleName": "KYU",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM D",
"AuthorizedOfficialTelephoneNumber": "310-472-6308",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "PHY21856",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}