{
"Npi": {
"NPI": "1275303109",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PERIOPDX",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "14780 SW OSPREY DR STE 240A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BEAVERTON",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97007-8424",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "503-747-0095",
"MailingAddressFaxNumber": "503-747-0027",
"FirstLinePracticeLocationAddress": "1130 SE 122ND AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PORTLAND",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97233-1112",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "503-252-5515",
"PracticeLocationAddressFaxNumber": "503-255-1625",
"EnumerationDate": "01/02/2024",
"LastUpdateDate": "01/02/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TRAN",
"AuthorizedOfficialFirstName": "DUY ANH",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "503-380-5872",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223P0300X",
"TaxonomyName": "Periodontics",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}