{
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"FirstLineMailingAddress": "10932 RATNER ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SUN VALLEY",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91352-4036",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-767-6022",
"MailingAddressFaxNumber": "818-767-6196",
"FirstLinePracticeLocationAddress": "10932 RATNER ST",
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"PracticeLocationAddressCityName": "SUN VALLEY",
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"PracticeLocationAddressFaxNumber": "818-767-6196",
"EnumerationDate": "04/13/2016",
"LastUpdateDate": "04/13/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FARKAS",
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"AuthorizedOfficialMiddleName": "E",
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"AuthorizedOfficialCredential": "D.D.S.,",
"AuthorizedOfficialTelephoneNumber": "818-767-6022",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "19874",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}