{
"Npi": {
"NPI": "1114132107",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "KEON-JUNG KIM DENTAL CORP.",
"ParentOrgTIN": null,
"OrgName": "KEON-JUNG KIM PROFESSIONAL DENTAL CORPORATION",
"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": "3257 CAMINO DE LOS COCHES",
"SecondLineMailingAddress": "#303",
"MailingAddressCityName": "CARLSBAD",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92009-8966",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "760-479-9876",
"MailingAddressFaxNumber": "760-479-0028",
"FirstLinePracticeLocationAddress": "3257 CAMINO DE LOS COCHES",
"SecondLinePracticeLocationAddress": "#303",
"PracticeLocationAddressCityName": "CARLSBAD",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92009-8966",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-479-9876",
"PracticeLocationAddressFaxNumber": "760-479-0028",
"EnumerationDate": "05/11/2007",
"LastUpdateDate": "08/23/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KIM",
"AuthorizedOfficialFirstName": "KEON-JUNG",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "760-479-9876",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "47919",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}