{
"Npi": {
"NPI": "1245451350",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SUEBSANGUAN CHAN DENTAL P.C",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "175 MEMORIAL HWY",
"SecondLineMailingAddress": "SUITE 1-11",
"MailingAddressCityName": "NEW ROCHELLE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10801-5635",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "914-235-4330",
"MailingAddressFaxNumber": "914-235-2006",
"FirstLinePracticeLocationAddress": "175 MEMORIAL HWY",
"SecondLinePracticeLocationAddress": "SUITE 1-11",
"PracticeLocationAddressCityName": "NEW ROCHELLE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10801-5635",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "914-235-4330",
"PracticeLocationAddressFaxNumber": "914-235-2006",
"EnumerationDate": "05/02/2007",
"LastUpdateDate": "07/31/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHAN",
"AuthorizedOfficialFirstName": "DENNIS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNERDENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "914-235-4330",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "049221",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}