{
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"FirstLineMailingAddress": "5200 VIRGINIA WAY",
"SecondLineMailingAddress": "L&C DEPT",
"MailingAddressCityName": "BRENTWOOD",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37027-7569",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "56845 29 PALMS HWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "YUCCA VALLEY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92284-2940",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-365-8706",
"PracticeLocationAddressFaxNumber": "760-228-0154",
"EnumerationDate": "02/16/2006",
"LastUpdateDate": "08/20/2025",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WEY",
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"AuthorizedOfficialTelephoneNumber": "615-341-6641",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QE0700X",
"TaxonomyName": "End-Stage Renal Disease (ESRD) Treatment Clinic/Center",
"LicenseNumber": "240000630",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}