{
"Npi": {
"NPI": "1134384407",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MARJAN CHEGOUNCHI MD INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 390005",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN DIEGO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92149-0005",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-746-6530",
"MailingAddressFaxNumber": "619-746-6528",
"FirstLinePracticeLocationAddress": "501 E HARDY ST",
"SecondLinePracticeLocationAddress": "STE 205",
"PracticeLocationAddressCityName": "INGLEWOOD",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90301-4054",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-671-6364",
"PracticeLocationAddressFaxNumber": "310-671-8184",
"EnumerationDate": "07/25/2008",
"LastUpdateDate": "06/25/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHEGOUNCHI",
"AuthorizedOfficialFirstName": "MARJAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "619-746-6530",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207RN0300X",
"TaxonomyName": "Nephrology Physician",
"LicenseNumber": "A80479",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}