{
"Npi": {
"NPI": "1265646905",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JOHN & ELIZABETH NGUYEN DENTAL CORP",
"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": "5733 NEWFIELDS LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DUBLIN",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94568-8781",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "925-719-0532",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1352 CONCANNON BLVD",
"SecondLinePracticeLocationAddress": "BUILDING H",
"PracticeLocationAddressCityName": "LIVERMORE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94550-6004",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "925-961-1101",
"PracticeLocationAddressFaxNumber": "925-961-1126",
"EnumerationDate": "05/10/2007",
"LastUpdateDate": "04/13/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NGUYEN",
"AuthorizedOfficialFirstName": "JOHN",
"AuthorizedOfficialMiddleName": "TIEN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "925-961-1101",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "50962",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}