{
"Npi": {
"NPI": "1205114501",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HIDEKI IKEDA D.D.S., M.S., DENTAL CORPORATION",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "12777 VALLEY VIEW ST..",
"SecondLineMailingAddress": "SUITE 222",
"MailingAddressCityName": "GARDEN GROVE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92845",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-893-7539",
"MailingAddressFaxNumber": "714-893-6736",
"FirstLinePracticeLocationAddress": "12777 VALLEY VIEW ST..",
"SecondLinePracticeLocationAddress": "SUITE 222",
"PracticeLocationAddressCityName": "GARDEN GROVE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92845",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-893-7539",
"PracticeLocationAddressFaxNumber": "714-893-6736",
"EnumerationDate": "08/03/2011",
"LastUpdateDate": "08/03/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "IKEDA",
"AuthorizedOfficialFirstName": "HIDEKI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "714-893-7539",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223X0400X",
"TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
"LicenseNumber": "58404",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}