{
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"LastName": null,
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"NamePrefix": null,
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"Credential": null,
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"FirstLineMailingAddress": "451 E CARSON PLAZA DR",
"SecondLineMailingAddress": "SUITE 105",
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"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90746-3247",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-354-0031",
"MailingAddressFaxNumber": "310-354-3939",
"FirstLinePracticeLocationAddress": "451 E CARSON PLAZA DR",
"SecondLinePracticeLocationAddress": "SUITE 105",
"PracticeLocationAddressCityName": "CARSON",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-354-0031",
"PracticeLocationAddressFaxNumber": "310-354-3939",
"EnumerationDate": "12/29/2014",
"LastUpdateDate": "12/29/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PICHAY",
"AuthorizedOfficialFirstName": "ANGELICA",
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"AuthorizedOfficialCredential": "MBA",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Voluntary or Charitable Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}