{
"Npi": {
"NPI": "1295270734",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WALTER JEFFERSON, D.D.S., INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "17000 RED HILL AVENUE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "IRVINE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92614",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-845-8890",
"MailingAddressFaxNumber": "949-474-1495",
"FirstLinePracticeLocationAddress": "612 E CARSON ST",
"SecondLinePracticeLocationAddress": "SUITE 101",
"PracticeLocationAddressCityName": "CARSON",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90745",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-469-9355",
"PracticeLocationAddressFaxNumber": "310-414-0800",
"EnumerationDate": "12/19/2016",
"LastUpdateDate": "12/22/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JEFFERSON",
"AuthorizedOfficialFirstName": "WALTER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "310-469-9355",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}