{
"Npi": {
"NPI": "1093073462",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PHAN CHIROPRACTIC",
"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": "2470 ALVIN AVE",
"SecondLineMailingAddress": "SUITE 30",
"MailingAddressCityName": "SAN JOSE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95121-1664",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "408-528-9000",
"MailingAddressFaxNumber": "408-528-9008",
"FirstLinePracticeLocationAddress": "2470 ALVIN AVE.",
"SecondLinePracticeLocationAddress": "SUITE 30",
"PracticeLocationAddressCityName": "SAN JOSE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95121-1664",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "408-528-9000",
"PracticeLocationAddressFaxNumber": "408-528-9008",
"EnumerationDate": "04/24/2012",
"LastUpdateDate": "04/24/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PHAN",
"AuthorizedOfficialFirstName": "GIA-HUNG",
"AuthorizedOfficialMiddleName": "LONG",
"AuthorizedOfficialTitle": "DOCTOR/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C",
"AuthorizedOfficialTelephoneNumber": "408-528-9000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302R00000X",
"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": "DC29087",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}