{
"Npi": {
"NPI": "1265879803",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BAHAIE-KHANI",
"FirstName": "NOOSHIN",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M. D., PHD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BAHAIE",
"OtherFirstName": "NOOSHIN",
"OtherMiddleName": "S",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "10666 N TORREY PINES RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LA JOLLA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92037-1092",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "858-554-6158",
"MailingAddressFaxNumber": "858-554-6565",
"FirstLinePracticeLocationAddress": "10790 RANCHO BERNARDO RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAN DIEGO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92127-5705",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "858-554-3235",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/22/2013",
"LastUpdateDate": "04/29/2019",
"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": "207RG0300X",
"TaxonomyName": "Geriatric Medicine (Internal Medicine) Physician",
"LicenseNumber": "138426",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}