{
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"FirstLineMailingAddress": "67-1185 MAMALAHOA HWY STE D104 #337",
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"MailingAddressStateName": "HI",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "65-1230 MAMALAHOA HWY STE E21",
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"PracticeLocationAddressTelephoneNumber": "808-887-8801",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/10/2022",
"LastUpdateDate": "06/10/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RIZK",
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"AuthorizedOfficialTitle": "MEMBER",
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"AuthorizedOfficialCredential": "DMD",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}