{
"Npi": {
"NPI": "1508106600",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GORDON",
"FirstName": "KALI",
"MiddleName": "L",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D., M.S.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "412 E NORTH ST UNIT A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALTURAS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "96101-4072",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "215-260-8867",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "PIT RIVER HEALTH SERVICE",
"SecondLinePracticeLocationAddress": "150 BUREAU OF INDIAN AFFAIRS #76A",
"PracticeLocationAddressCityName": "ALTURAS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "96101",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "530-233-3223",
"PracticeLocationAddressFaxNumber": "530-233-3296",
"EnumerationDate": "02/26/2013",
"LastUpdateDate": "11/09/2023",
"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": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "72733",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}