{
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"NamePrefix": null,
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"FirstLineMailingAddress": "PO BOX 1441",
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"MailingAddressCityName": "WAILUKU",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "808-242-4805",
"FirstLinePracticeLocationAddress": "2200 MAIN ST",
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"PracticeLocationAddressFaxNumber": "808-244-9677",
"EnumerationDate": "05/26/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RANDOLPH",
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"AuthorizedOfficialCredential": "M.D.",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Psychiatry Physician",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}