{
"Npi": {
"NPI": "1184952079",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GREAT WALL CLINIC",
"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": "18230 E VALLEY HWY",
"SecondLineMailingAddress": "168",
"MailingAddressCityName": "KENT",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98032-1259",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "18230 E VALLEY HWY",
"SecondLinePracticeLocationAddress": "168",
"PracticeLocationAddressCityName": "KENT",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98032-1259",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "425-656-9025",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/03/2009",
"LastUpdateDate": "12/03/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROLLOLAZO",
"AuthorizedOfficialFirstName": "EPHRAIM",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OFFICE MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "425-656-9025",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "DE00007365",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}