{
"Npi": {
"NPI": "1164617783",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SEVAK ELYASPOOR DDS PROFESSIONAL CORP.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "12125 VANOWEN ST STE 2",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH HOLLYWOOD",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91605-5665",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-764-4679",
"MailingAddressFaxNumber": "818-764-6382",
"FirstLinePracticeLocationAddress": "12125 VANOWEN ST STE 2",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORTH HOLLYWOOD",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91605-5665",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-764-4679",
"PracticeLocationAddressFaxNumber": "818-764-6382",
"EnumerationDate": "09/06/2007",
"LastUpdateDate": "09/06/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ELYASPOOR",
"AuthorizedOfficialFirstName": "SEVAK",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "818-764-4679",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "53593",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}