{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 3856",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HUNTINGTON BEACH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92605-3856",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "562-594-6888",
"MailingAddressFaxNumber": "562-594-4888",
"FirstLinePracticeLocationAddress": "10879 LOS ALAMITOS BLVD",
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"PracticeLocationAddressCityName": "LOS ALAMITOS",
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"PracticeLocationAddressPostalCode": "90720-2329",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "562-594-6888",
"PracticeLocationAddressFaxNumber": "562-594-4888",
"EnumerationDate": "05/31/2007",
"LastUpdateDate": "06/01/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAI",
"AuthorizedOfficialFirstName": "THAO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PRESIDENT/PIC",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM.D.",
"AuthorizedOfficialTelephoneNumber": "562-594-6888",
"Taxonomies": {
"Taxonomy": [
{
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"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
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},
{
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},
{
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"LicenseNumberStateCode": null,
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},
{
"TaxonomyCode": "332B00000X",
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"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHY51990",
"LicenseNumberStateCode": "CA",
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}