{
"Npi": {
"NPI": "1306149083",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DRAYTON P GRAHAM A MEDICAL CORPORATION",
"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": "4477 W 118TH ST STE 405",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAWTHORNE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90250-2259",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-970-1930",
"MailingAddressFaxNumber": "928-268-0107",
"FirstLinePracticeLocationAddress": "4477 W 118TH ST",
"SecondLinePracticeLocationAddress": "STE. 401",
"PracticeLocationAddressCityName": "HAWTHORNE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90250-2255",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-970-1930",
"PracticeLocationAddressFaxNumber": "310-970-1979",
"EnumerationDate": "12/17/2010",
"LastUpdateDate": "04/10/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GRAHAM",
"AuthorizedOfficialFirstName": "DRAYTON",
"AuthorizedOfficialMiddleName": "P",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "310-970-1930",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207RP1001X",
"TaxonomyName": "Pulmonary Disease Physician",
"LicenseNumber": "G27833",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "G27833",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}