{
"Npi": {
"NPI": "1124492087",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "EZEJI-OKOYE",
"FirstName": "CHINEDU",
"MiddleName": "JOHN",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DDS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "OKOYE",
"OtherFirstName": "JOHN",
"OtherMiddleName": null,
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "DDS",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "1519 HIGH PARK DRIVE NW",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HIGH RIVER",
"MailingAddressStateName": "AB",
"MailingAddressPostalCode": "T1V0A4",
"MailingAddressCountryCode": "CA",
"MailingAddressTelephoneNumber": "403-701-6272",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1526 5TH AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAN RAFAEL",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94901-1852",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "415-453-6409",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/16/2015",
"LastUpdateDate": "11/16/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "44586",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}