{
"Npi": {
"NPI": "1083814784",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KIM",
"FirstName": "SOOMIN",
"MiddleName": "RICHARD",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DDS, MPH",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6423 ESCENA BLVD #1070",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "IRVING",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75039-3159",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "213-999-7177",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6423 ESCENA BLVD UNIT 1070",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "IRVING",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75039-4268",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "213-999-7177",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/20/2007",
"LastUpdateDate": "08/27/2012",
"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": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "23450",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "56019",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}