{
"Npi": {
"NPI": "1053594846",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "ZZZ25706Z",
"ParentOrgTIN": null,
"OrgName": "SOO YOUN KIM OD INC",
"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": "14147 PIPELINE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHINO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91710-5618",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-628-0300",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "14147 PIPELINE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHINO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91710-5618",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-628-0300",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/14/2007",
"LastUpdateDate": "01/23/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KIM",
"AuthorizedOfficialFirstName": "SOO",
"AuthorizedOfficialMiddleName": "YOUN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D",
"AuthorizedOfficialTelephoneNumber": "909-628-0300",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "OPT10349TPA",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}