{
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"SecondLineMailingAddress": null,
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"MailingAddressStateName": "CA",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "650-214-6369",
"MailingAddressFaxNumber": "650-253-2302",
"FirstLinePracticeLocationAddress": "321 HAMPTON DR",
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"PracticeLocationAddressTelephoneNumber": "650-214-6369",
"PracticeLocationAddressFaxNumber": "650-253-2302",
"EnumerationDate": "11/19/2011",
"LastUpdateDate": "11/19/2011",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEES",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "408-348-4214",
"Taxonomies": {
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"TaxonomyName": "Non-Pharmacy Dispensing Site",
"LicenseNumber": "A 73520",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}