{
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"EIN": null,
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"OtherOrgName": null,
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"OtherLastName": "SADEGHI",
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"OtherCredential": "D.O.",
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"FirstLineMailingAddress": "28632 ROADSIDE DR",
"SecondLineMailingAddress": "SUITE 105",
"MailingAddressCityName": "AGOURA HILLS",
"MailingAddressStateName": "CA",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-452-4483",
"MailingAddressFaxNumber": "818-452-4488",
"FirstLinePracticeLocationAddress": "28632 ROADSIDE DR",
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"PracticeLocationAddressCityName": "AGOURA HILLS",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-452-4483",
"PracticeLocationAddressFaxNumber": "818-452-4488",
"EnumerationDate": "05/21/2007",
"LastUpdateDate": "06/06/2022",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "20A8718",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}