{
"Npi": {
"NPI": "1134275951",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "AVANESIAN",
"FirstName": "AIDA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LAC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5250 SANTA MONICA BLVD",
"SecondLineMailingAddress": "SUITE 304",
"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90029",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "323-953-1000",
"MailingAddressFaxNumber": "323-953-1000",
"FirstLinePracticeLocationAddress": "201 N BELMONT ST",
"SecondLinePracticeLocationAddress": "APT 104",
"PracticeLocationAddressCityName": "GLENDALE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91206-4925",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-484-6342",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/26/2007",
"LastUpdateDate": "05/29/2008",
"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": "171100000X",
"TaxonomyName": "Acupuncturist",
"LicenseNumber": "AC 11057",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}