{
"Npi": {
"NPI": "1255573705",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KOONER",
"FirstName": "PAVANDEEP",
"MiddleName": "KAUR",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DMD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "12776 61ST AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SURREY",
"MailingAddressStateName": "BC",
"MailingAddressPostalCode": "V3X3M6",
"MailingAddressCountryCode": "CA",
"MailingAddressTelephoneNumber": "17788586232",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "UNIT 108",
"SecondLinePracticeLocationAddress": "8501 162ND STREET",
"PracticeLocationAddressCityName": "SURREY",
"PracticeLocationAddressStateName": "BC",
"PracticeLocationAddressPostalCode": "V4N1B2",
"PracticeLocationAddressCountryCode": "CA",
"PracticeLocationAddressTelephoneNumber": "17788586232",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/30/2009",
"LastUpdateDate": "07/02/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "58153",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}