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1063311371 NPI number — SJT VENTURES WI LLC

NPI Number: 1063311371
Health Care Provider/Practitioner: SJT VENTURES WI LLC

Information about “1063311371” NPI (SJT VENTURES WI LLC) exists in 1063311371 in HTML format HTML  |  1063311371 in plain Text format TXT  |  1063311371 in PDF (Portable Document Format) PDF  |  1063311371 in an XML format XML  formats.

NPI Number : 1063311371 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063311371",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "SJT VENTURES",
    "ParentOrgTIN": null,
    "OrgName": "SJT VENTURES WI LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "17595 HARVARD AVE STE C",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "IRVINE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92614-8522",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "949-688-3903",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2800 E ENTERPRISE AVE STE 333",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "APPLETON",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54913-7889",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "949-688-3903",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/03/2026",
    "LastUpdateDate": "11/03/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "THANKACHEN",
    "AuthorizedOfficialFirstName": "SANJAI",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "949-688-3903",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103TA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Psychologist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0802X",
          "TaxonomyName": "Addiction Psychiatry Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "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."
        },
        {
          "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."
        },
        {
          "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."
        }
      ]
    }
  }
}
                
            

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