{
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"NamePrefix": null,
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"FirstLineMailingAddress": "17185 ARROW BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FONTANA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92335-3972",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-822-4777",
"MailingAddressFaxNumber": "909-822-2926",
"FirstLinePracticeLocationAddress": "17185 ARROW BLVD",
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"PracticeLocationAddressCityName": "FONTANA",
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"PracticeLocationAddressTelephoneNumber": "909-822-4777",
"PracticeLocationAddressFaxNumber": "909-822-2926",
"EnumerationDate": "01/05/2015",
"LastUpdateDate": "01/05/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TRINH",
"AuthorizedOfficialFirstName": "MATT-PHUOC",
"AuthorizedOfficialMiddleName": "QUY",
"AuthorizedOfficialTitle": "C.E.O.",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "909-822-4777",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dentist",
"LicenseNumber": "55574",
"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."
}
}
}
}