{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "OC PAIN DOCTOR PC",
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"NamePrefix": null,
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"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1254 IRVINE BLVD",
"SecondLineMailingAddress": "SUITE 150",
"MailingAddressCityName": "TUSTIN",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92780-3509",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-669-0399",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1254 IRVINE BLVD",
"SecondLinePracticeLocationAddress": "SUITE 150",
"PracticeLocationAddressCityName": "TUSTIN",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressTelephoneNumber": "714-669-0399",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/27/2015",
"LastUpdateDate": "03/30/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KAKAR",
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"AuthorizedOfficialMiddleName": "RANI",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "714-669-0399",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Preferred Provider Organization",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}