{
"Npi": {
"NPI": "1043576242",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KT DENTAL LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "95 S SHERIDAN BLVD",
"SecondLineMailingAddress": "SUITE C",
"MailingAddressCityName": "LAKEWOOD",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80226-2445",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "720-524-3959",
"MailingAddressFaxNumber": "720-596-4482",
"FirstLinePracticeLocationAddress": "95 S SHERIDAN BLVD",
"SecondLinePracticeLocationAddress": "SUITE C",
"PracticeLocationAddressCityName": "LAKEWOOD",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80226-2445",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "720-524-3959",
"PracticeLocationAddressFaxNumber": "720-596-4482",
"EnumerationDate": "04/02/2012",
"LastUpdateDate": "04/02/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HOANG XUAN",
"AuthorizedOfficialFirstName": "DUY KHIEM",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DOCTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "720-524-3959",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "8352",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}