{
"Npi": {
"NPI": "1184303356",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "VIDAL",
"FirstName": "KOURTNEY",
"MiddleName": "KATE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LVN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "KLEEFISCH",
"OtherFirstName": "JAIRUS",
"OtherMiddleName": "VIDAL",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "LVN",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1601 N SEPULVEDA BLVD # 605",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MANHATTAN BEACH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90266-5111",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "424-542-1280",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7742 PASEO DEL REY APT 6",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PLAYA DEL REY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90293-8343",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "562-552-7646",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/14/2023",
"LastUpdateDate": "07/14/2023",
"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": "164X00000X",
"TaxonomyName": "Licensed Vocational Nurse",
"LicenseNumber": "VN726574",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}