{
"Npi": {
"NPI": "1124423926",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CHUNG",
"FirstName": "YUSHAN",
"MiddleName": "HSIEH",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "MPH, LCSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "HSIEH",
"OtherFirstName": "YUSHAN",
"OtherMiddleName": null,
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": "MPH, LCSW",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1954 KATELAND CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "APEX",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27502-6611",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "646-397-0624",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1954 KATELAND CT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "APEX",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27502-6611",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "646-397-0624",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/23/2014",
"LastUpdateDate": "04/17/2024",
"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": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "C013947",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "44SC05895800",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "088374",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}