{
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"FirstLineMailingAddress": "PO BOX 1551",
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"MailingAddressCityName": "RIVERSIDE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92502-1551",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "951-231-2402",
"MailingAddressFaxNumber": "951-688-8451",
"FirstLinePracticeLocationAddress": "3838 SHERMAN DR STE 6",
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"PracticeLocationAddressCityName": "RIVERSIDE",
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"PracticeLocationAddressTelephoneNumber": "951-231-2402",
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"EnumerationDate": "09/11/2007",
"LastUpdateDate": "09/11/2007",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KUVHENGUHWA",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "951-231-2402",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Surgery Physician",
"LicenseNumber": "G59257",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}