{
"Npi": {
"NPI": "1487686556",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HOOSHANG DALAVARIAN, INC",
"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": "100 TUSTIN AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TUSTIN",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92780",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-285-2950",
"MailingAddressFaxNumber": "714-285-2960",
"FirstLinePracticeLocationAddress": "100 TUSTIN AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TUSTIN",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92780",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-285-2950",
"PracticeLocationAddressFaxNumber": "714-285-2960",
"EnumerationDate": "07/07/2006",
"LastUpdateDate": "11/28/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DALAVARIAN",
"AuthorizedOfficialFirstName": "HOOSHANG",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PH.D",
"AuthorizedOfficialTelephoneNumber": "714-285-2950",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "291U00000X",
"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": "CLF 11532",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}