{
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"EIN": null,
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"OtherLastName": "KEITH",
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"OtherCredential": "M.D.",
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"FirstLineMailingAddress": "6200 WILSHIRE BLVD STE 1111",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90048-5812",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "323-932-0382",
"MailingAddressFaxNumber": "323-932-0653",
"FirstLinePracticeLocationAddress": "6200 WILSHIRE BLVD",
"SecondLinePracticeLocationAddress": "SUITE 1111",
"PracticeLocationAddressCityName": "LOS ANGELES",
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"PracticeLocationAddressPostalCode": "90048-5801",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "323-932-0382",
"PracticeLocationAddressFaxNumber": "323-932-0653",
"EnumerationDate": "02/07/2007",
"LastUpdateDate": "07/09/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207N00000X",
"TaxonomyName": "Dermatology Physician",
"LicenseNumber": "G28270",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}