{
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"LastName": "MAHADEV",
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"FirstLineMailingAddress": "1959 NE PACIFIC ST",
"SecondLineMailingAddress": "BOX 356410",
"MailingAddressCityName": "SEATTLE",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98195-6410",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-397-5742",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1959 NE PACIFIC ST",
"SecondLinePracticeLocationAddress": "BOX 356410",
"PracticeLocationAddressCityName": "SEATTLE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-397-5742",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/14/2015",
"LastUpdateDate": "10/05/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
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"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "MD61017974",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}