{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "OHANA DENTAL OF KAHALA LLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
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"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1000 AUAHI ST APT 3806",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HONOLULU",
"MailingAddressStateName": "HI",
"MailingAddressPostalCode": "96814-3378",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4211 WAIALAE AVE STE 500",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HONOLULU",
"PracticeLocationAddressStateName": "HI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "808-735-7777",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/14/2024",
"LastUpdateDate": "09/14/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KIM",
"AuthorizedOfficialFirstName": "ELLIOT",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "808-277-9026",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}