{
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"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "DENTAL GROUP OF DONG SHIN, DDS, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "40803 FREMONT BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FREMONT",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94538",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "510-933-0088",
"MailingAddressFaxNumber": "510-933-0080",
"FirstLinePracticeLocationAddress": "40803 FREMONT BLVD",
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"PracticeLocationAddressCityName": "FREMONT",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "510-933-0088",
"PracticeLocationAddressFaxNumber": "510-933-0080",
"EnumerationDate": "05/04/2011",
"LastUpdateDate": "05/07/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHIN",
"AuthorizedOfficialFirstName": "DONG-YOUN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT OR DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "408-499-8938",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "57509",
"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."
}
}
}
}