{
"Npi": {
"NPI": "1144537606",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KOO",
"FirstName": "JASMINE",
"MiddleName": "JAMIN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "KOO",
"OtherFirstName": "JAMIN",
"OtherMiddleName": null,
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": "MD",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "1601 E PFLUGERVILLE PKWY STE 3201",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PFLUGERVILLE",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78660-7349",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "206-450-6845",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1601 E PFLUGERVILLE PKWY STE 3201",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PFLUGERVILLE",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78660-7349",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "206-450-6845",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/04/2010",
"LastUpdateDate": "11/18/2024",
"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": "2085R0204X",
"TaxonomyName": "Vascular & Interventional Radiology Physician",
"LicenseNumber": "C164186",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2085R0204X",
"TaxonomyName": "Vascular & Interventional Radiology Physician",
"LicenseNumber": "R4863",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}