1497909154 NPI number — CHARLENE DICHOSO DOMINGO-YAMAMOTO L.AC., M.AC.O.M.

NPI Number: 1497909154
Health Care Provider/Practitioner: CHARLENE DICHOSO DOMINGO-YAMAMOTO L.AC., M.AC.O.M.

NPI Number : 1497909154 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497909154",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DOMINGO-YAMAMOTO",
    "FirstName": "CHARLENE",
    "MiddleName": "DICHOSO",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "L.AC., M.AC.O.M.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "9159 W DESERT INN RD APT J104",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAS VEGAS",
    "MailingAddressStateName": "NV",
    "MailingAddressPostalCode": "89117-6372",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "808-554-3257",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1750 KALAKAUA AVE",
    "SecondLinePracticeLocationAddress": "SUITE 808",
    "PracticeLocationAddressCityName": "HONOLULU",
    "PracticeLocationAddressStateName": "HI",
    "PracticeLocationAddressPostalCode": "96826-3766",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "808-589-6937",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/07/2008",
    "LastUpdateDate": "10/26/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "106S00000X",
        "TaxonomyName": "Behavior Technician",
        "LicenseNumber": "RBT2888",
        "LicenseNumberStateCode": "NV",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}