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1316950926 NPI number — MIKHAI CONG TA DDS

NPI Number: 1316950926
Health Care Provider/Practitioner: MIKHAI CONG TA DDS

Information about “1316950926” NPI (MIKHAI CONG TA DDS) exists in 1316950926 in HTML format HTML  |  1316950926 in plain Text format TXT  |  1316950926 in PDF (Portable Document Format) PDF  |  1316950926 in an XML format XML  formats.

NPI Number : 1316950926 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1316950926",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TA",
    "FirstName": "MIKHAI",
    "MiddleName": "CONG",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5734 CANYON VIEW DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PARADISE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95969-5503",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5734 CANYON VIEW DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PARADISE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95969-5503",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "530-876-7179",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/14/2006",
    "LastUpdateDate": "10/03/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "10476",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "102306",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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