{
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"FirstLineMailingAddress": "13625 MAPLE AVE",
"SecondLineMailingAddress": "SUITE 205",
"MailingAddressCityName": "FLUSHING",
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"MailingAddressPostalCode": "11355-3870",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-463-2245",
"MailingAddressFaxNumber": "718-463-2290",
"FirstLinePracticeLocationAddress": "13625 MAPLE AVE",
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"EnumerationDate": "01/27/2011",
"LastUpdateDate": "01/27/2011",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "SHUM",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "151697",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}