{
"Npi": {
"NPI": "1114292406",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GIPSON",
"FirstName": "SHIH",
"MiddleName": "YEE-MARIE TAN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "TAN",
"OtherFirstName": "SHIH",
"OtherMiddleName": "YEE-MARIE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "M.D.",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "185 CAMBRIDGE ST FL 2",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOSTON",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "02114-2790",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "617-643-2780",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "18 GROVE ST # 6",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WELLESLEY",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "02482-7705",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "617-326-5102",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/20/2012",
"LastUpdateDate": "08/29/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2084P0800X",
"TaxonomyName": "Psychiatry Physician",
"LicenseNumber": "262376",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2084P0804X",
"TaxonomyName": "Child & Adolescent Psychiatry Physician",
"LicenseNumber": "262376",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2084P0804X",
"TaxonomyName": "Child & Adolescent Psychiatry Physician",
"LicenseNumber": "A155011",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "390200000X",
"TaxonomyName": "Student in an Organized Health Care Education/Training Program",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2084P0800X",
"TaxonomyName": "Psychiatry Physician",
"LicenseNumber": "A155011",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}