{
"Npi": {
"NPI": "1265542302",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "TAHERI",
"FirstName": "MOHAMMAD",
"MiddleName": "REZA",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MD, PHD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "TAHERI",
"OtherFirstName": "M",
"OtherMiddleName": "REZA",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MD, PHD",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "834 SW 122ND ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SEATTLE",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98146-2737",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "206-328-4861",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1959 NE PACIFIC ST",
"SecondLinePracticeLocationAddress": "C-212, BOX 356340",
"PracticeLocationAddressCityName": "SEATTLE",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98195-6340",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "206-543-0065",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/30/2006",
"LastUpdateDate": "01/19/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2085R0202X",
"TaxonomyName": "Diagnostic Radiology Physician",
"LicenseNumber": "ML20008387",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}