{
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOPHIA ROZOV DDS, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5640 ETIWANDA AVE",
"SecondLineMailingAddress": "# 5",
"MailingAddressCityName": "TARZANA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91356-2700",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "562-904-0400",
"MailingAddressFaxNumber": "562-904-1803",
"FirstLinePracticeLocationAddress": "8543 ROSEMEAD BLVD",
"SecondLinePracticeLocationAddress": "# D",
"PracticeLocationAddressCityName": "PICO RIVERA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90660-5427",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "562-904-0400",
"PracticeLocationAddressFaxNumber": "562-904-1803",
"EnumerationDate": "03/20/2007",
"LastUpdateDate": "01/22/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROZOV",
"AuthorizedOfficialFirstName": "SOPHIA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "562-904-0400",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "45820",
"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."
}
}
}
}