{
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"FirstLineMailingAddress": "3600 SHIRE BLVD STE 208",
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"MailingAddressCityName": "RICHARDSON",
"MailingAddressStateName": "TX",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "3600 SHIRE BLVD STE 208",
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"EnumerationDate": "08/12/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "TRAN",
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"AuthorizedOfficialCredential": "LPS-SUPERVISOR",
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"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}