{
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"OrgName": "MAI TANG OD, INC",
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"FirstLineMailingAddress": "5365 GRANBY DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "YORBA LINDA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92887-3712",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-924-2552",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1893 W MALVERN AVE",
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"PracticeLocationAddressCityName": "FULLERTON",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressFaxNumber": "714-278-9075",
"EnumerationDate": "05/09/2012",
"LastUpdateDate": "10/12/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TANG",
"AuthorizedOfficialFirstName": "MAI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "714-924-2552",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Optometrist",
"LicenseNumber": "10595T",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
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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."
}
}
}
}