{
"Npi": {
"NPI": "1336317403",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NKEM IHEANAJU",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 1541",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAWTHORNE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90251-1541",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-221-5310",
"MailingAddressFaxNumber": "310-834-6119",
"FirstLinePracticeLocationAddress": "1300 E 223RD ST",
"SecondLinePracticeLocationAddress": "SUITE 407",
"PracticeLocationAddressCityName": "CARSON",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90745-4355",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-221-5310",
"PracticeLocationAddressFaxNumber": "310-834-6119",
"EnumerationDate": "02/12/2008",
"LastUpdateDate": "03/14/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "IHEANAJU",
"AuthorizedOfficialFirstName": "NKEM",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT/OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "310-221-5310",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": "103335",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "103335",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}