{
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"EIN": null,
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"FirstLineMailingAddress": "444 S SAN VICENTE BLVD",
"SecondLineMailingAddress": "#104",
"MailingAddressCityName": "LOS ANGELES",
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"MailingAddressPostalCode": "90048-4165",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-423-9550",
"MailingAddressFaxNumber": "310-423-9551",
"FirstLinePracticeLocationAddress": "444 S SAN VICENTE BLVD",
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"PracticeLocationAddressTelephoneNumber": "310-423-9550",
"PracticeLocationAddressFaxNumber": "310-423-9551",
"EnumerationDate": "02/01/2006",
"LastUpdateDate": "04/24/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FRIEDBERG",
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"AuthorizedOfficialMiddleName": "ANN",
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"AuthorizedOfficialCredential": "R.PH.",
"AuthorizedOfficialTelephoneNumber": "310-423-9550",
"Taxonomies": {
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"LicenseNumber": "PHY34810",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}