{
"Npi": {
"NPI": "1417231630",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KING'S PHARMACY AND COMPOUNDING CENTER",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "510 SUPERIOR AVE",
"SecondLineMailingAddress": "SUITE 120",
"MailingAddressCityName": "NEWPORT BEACH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92663-3663",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "949-631-4624",
"MailingAddressFaxNumber": "949-631-4626",
"FirstLinePracticeLocationAddress": "510 SUPERIOR AVE STE 120",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEWPORT BEACH",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92663-3665",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "949-631-4624",
"PracticeLocationAddressFaxNumber": "949-631-4626",
"EnumerationDate": "10/06/2011",
"LastUpdateDate": "05/09/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REZAEI",
"AuthorizedOfficialFirstName": "ALI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PIC/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "949-244-9415",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336C0004X",
"TaxonomyName": "Compounding Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHY50750",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}