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1053841197 NPI number — JIEAN JOSEPH HEIFETZ-LI DMD, MPH

NPI Number: 1053841197
Health Care Provider/Practitioner: JIEAN JOSEPH HEIFETZ-LI DMD, MPH

Information about “1053841197” NPI (JIEAN JOSEPH HEIFETZ-LI DMD, MPH) exists in 1053841197 in HTML format HTML  |  1053841197 in plain Text format TXT  |  1053841197 in PDF (Portable Document Format) PDF  |  1053841197 in an XML format XML  formats.

NPI Number : 1053841197 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053841197",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HEIFETZ-LI",
    "FirstName": "JIEAN JOSEPH",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DMD, MPH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "246 GOOSE LN STE 204",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GUILFORD",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06437-2186",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "203-453-4381",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "246 GOOSE LN STE 204",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GUILFORD",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06437-2186",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "203-453-4381",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/12/2017",
    "LastUpdateDate": "06/23/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223S0112X",
        "TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
        "LicenseNumber": "13319",
        "LicenseNumberStateCode": "CT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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