{
"Npi": {
"NPI": "1174796445",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KAVITHA K NAKKA, MD INC.",
"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": "12601 WINTER WREN CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OAK HILL",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "20171-1830",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-560-0404",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8301 ARLINGTON BLVD",
"SecondLinePracticeLocationAddress": "SUITE # T-5",
"PracticeLocationAddressCityName": "FAIRFAX",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22031-2902",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "703-560-0404",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/08/2008",
"LastUpdateDate": "09/05/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NAKKA",
"AuthorizedOfficialFirstName": "KISHORE",
"AuthorizedOfficialMiddleName": "K",
"AuthorizedOfficialTitle": "OFFICER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "703-435-1713",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "06068936",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}