{
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"OrgName": "VICTORY PLAZA DENTAL GROUP DENTAL OFFICE OF FARNAZ KOHAN INC.",
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"FirstLineMailingAddress": "13065 VICTORY BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH HOLLYWOOD",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91606-2925",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-927-0726",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "13065 VICTORY BLVD",
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"PracticeLocationAddressCityName": "NORTH HOLLYWOOD",
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"PracticeLocationAddressTelephoneNumber": "818-927-0726",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/08/2017",
"LastUpdateDate": "01/11/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KOHAN",
"AuthorizedOfficialFirstName": "FARNAZ",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DENTIST",
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"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "818-927-0726",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "62906",
"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."
}
}
}
}