{
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"MiddleName": null,
"NamePrefix": null,
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"FirstLineMailingAddress": "2120 W 18TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HOUSTON",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77008-1210",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "713-861-7078",
"MailingAddressFaxNumber": "713-861-8065",
"FirstLinePracticeLocationAddress": "2120 W 18TH ST",
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"PracticeLocationAddressCityName": "HOUSTON",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77008-1210",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "713-861-7078",
"PracticeLocationAddressFaxNumber": "713-861-8065",
"EnumerationDate": "02/14/2007",
"LastUpdateDate": "05/29/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WONG",
"AuthorizedOfficialFirstName": "ANDREW",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "GENERAL PARTNER",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "713-861-7078",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
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"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1223G0001X",
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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{
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
]
}
}
}