NPI Code Detail JSON Logo

1104373745 NPI number — INTEGRATIVE DIAGNOSTIC GROUP INC

NPI Number: 1104373745
Health Care Provider/Practitioner: INTEGRATIVE DIAGNOSTIC GROUP INC

Information about “1104373745” NPI (INTEGRATIVE DIAGNOSTIC GROUP INC) exists in 1104373745 in HTML format HTML  |  1104373745 in plain Text format TXT  |  1104373745 in PDF (Portable Document Format) PDF  |  1104373745 in an XML format XML  formats.

NPI Number : 1104373745 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104373745",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "INTEGRATIVE DIAGNOSTIC GROUP INC",
    "ParentOrgTIN": null,
    "OrgName": "INTEGRATIVE DIAGNOSTIC GROUP INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1231 ARTESIA BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CERRITOS",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90703-2750",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "562-653-0180",
    "MailingAddressFaxNumber": "562-402-3029",
    "FirstLinePracticeLocationAddress": "12231 ARTESIA BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CERRITOS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90703-2750",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "562-653-0180",
    "PracticeLocationAddressFaxNumber": "562-402-3029",
    "EnumerationDate": "09/01/2016",
    "LastUpdateDate": "09/01/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GANGHI",
    "AuthorizedOfficialFirstName": "ANIL",
    "AuthorizedOfficialMiddleName": "K",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD.",
    "AuthorizedOfficialTelephoneNumber": "562-653-0180",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "323P00000X",
          "TaxonomyName": "Psychiatric Residential Treatment Facility",
          "LicenseNumber": "PSY6247",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207QA0505X",
          "TaxonomyName": "Adult Medicine Physician",
          "LicenseNumber": "A30411",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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