{
"Npi": {
"NPI": "1376688663",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ROZOV",
"FirstName": "SOPHIA",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DDS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BASIN",
"OtherFirstName": "SOPHIA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "DDS",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "5640 ETIWANDA AVE",
"SecondLineMailingAddress": "#5",
"MailingAddressCityName": "TARZANA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91356-2700",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-635-9141",
"MailingAddressFaxNumber": "818-705-7940",
"FirstLinePracticeLocationAddress": "19233 VENTURA BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TARZANA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91356-3122",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-705-7900",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/21/2007",
"LastUpdateDate": "07/18/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "45820",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}