{
"Npi": {
"NPI": "1396864021",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GANDHI",
"FirstName": "KIM",
"MiddleName": "KISHIN",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "D.D.S.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2247 PALM BEACH LAKES BLVD",
"SecondLineMailingAddress": "# 207",
"MailingAddressCityName": "WEST PALM BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33409",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-242-2861",
"MailingAddressFaxNumber": "561-242-2833",
"FirstLinePracticeLocationAddress": "2247 PALM BEACH LAKES BLVD",
"SecondLinePracticeLocationAddress": "# 207",
"PracticeLocationAddressCityName": "WEST PALM BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33409",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-242-2861",
"PracticeLocationAddressFaxNumber": "561-242-2833",
"EnumerationDate": "03/27/2007",
"LastUpdateDate": "11/20/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "1223P0300X",
"TaxonomyName": "Periodontics",
"LicenseNumber": "11592",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1223P0300X",
"TaxonomyName": "Periodontics",
"LicenseNumber": "DN11592",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}