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1013415678 NPI number — PROMISE INTEGRATIVE MEDICINE CLINIC RI

NPI Number: 1013415678
Health Care Provider/Practitioner: PROMISE INTEGRATIVE MEDICINE CLINIC RI

Information about “1013415678” NPI (PROMISE INTEGRATIVE MEDICINE CLINIC RI) exists in 1013415678 in HTML format HTML  |  1013415678 in plain Text format TXT  |  1013415678 in PDF (Portable Document Format) PDF  |  1013415678 in an XML format XML  formats.

NPI Number : 1013415678 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1013415678",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "PROMISE INTEGRATIVE MEDICINE CLINIC",
    "ParentOrgTIN": null,
    "OrgName": "PROMISE INTEGRATIVE MEDICINE CLINIC RI",
    "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": "535 ROOSEVELT AVE APT 611",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CENTRAL FALLS",
    "MailingAddressStateName": "RI",
    "MailingAddressPostalCode": "02863-3204",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2095 ELMWOOD AVE STE 1",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WARWICK",
    "PracticeLocationAddressStateName": "RI",
    "PracticeLocationAddressPostalCode": "02888-2405",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "401-787-1608",
    "PracticeLocationAddressFaxNumber": "401-633-7610",
    "EnumerationDate": "01/30/2018",
    "LastUpdateDate": "01/30/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "YEO",
    "AuthorizedOfficialFirstName": "HYUN SOO",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "DOCTOR OF ACUPUNCTURE ORIENTAL MEDI",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DAOM",
    "AuthorizedOfficialTelephoneNumber": "213-222-7481",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "171100000X",
        "TaxonomyName": "Acupuncturist",
        "LicenseNumber": "DAOM0056",
        "LicenseNumberStateCode": "RI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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