{
"Npi": {
"NPI": "1407040843",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SAN DIMAS SURGICAL MEDICAL CENTER INSTITUTE INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "221 N SAN DIMAS AVE",
"SecondLineMailingAddress": "SUITE 200",
"MailingAddressCityName": "SAN DIMAS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91773-2664",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-592-0142",
"MailingAddressFaxNumber": "909-592-0339",
"FirstLinePracticeLocationAddress": "221 N SAN DIMAS AVE",
"SecondLinePracticeLocationAddress": "SUITE 200",
"PracticeLocationAddressCityName": "SAN DIMAS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91773-2664",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-592-0142",
"PracticeLocationAddressFaxNumber": "909-592-0339",
"EnumerationDate": "08/29/2007",
"LastUpdateDate": "07/08/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SOROKURS",
"AuthorizedOfficialFirstName": "ALEXANDER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "909-592-0142",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "FNP31533",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}