{
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"NamePrefix": null,
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"FirstLineMailingAddress": "4215 DALE BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WOODBRIDGE",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22193-2243",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "34-571-0497",
"MailingAddressFaxNumber": "571-659-9028",
"FirstLinePracticeLocationAddress": "4215 DALE BLVD",
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"PracticeLocationAddressCityName": "WOODBRIDGE",
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"PracticeLocationAddressTelephoneNumber": "703-457-1049",
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"EnumerationDate": "07/20/2017",
"LastUpdateDate": "10/05/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KINTU",
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"AuthorizedOfficialCredential": "PHARM D",
"AuthorizedOfficialTelephoneNumber": "703-878-1837",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336L0003X",
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"PrimaryTaxonomySwitch": "N"
},
{
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}
]
},
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}
}