{
"Npi": {
"NPI": "1184111254",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "TAGHIZADEH-TOOSSI",
"FirstName": "HESSAM",
"MiddleName": "M",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DDS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "TOOSSI",
"OtherFirstName": "HESSAM",
"OtherMiddleName": "T",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "DDS",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "7742 REDLANDS ST UNIT D1041",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PLAYA DEL REY",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90293-7403",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "131-035-1774",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5029 KANAN RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "AGOURA HILLS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91301-2515",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-991-9853",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/15/2018",
"LastUpdateDate": "12/04/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "104152",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}