{
"Npi": {
"NPI": "1508273665",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KAWABORI",
"FirstName": "MASASHI",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "33 POND AVE",
"SecondLineMailingAddress": "#504",
"MailingAddressCityName": "BROOKLINE",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "02445-7163",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "617-784-6480",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "740 S LIMESTONE STE L304",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LEXINGTON",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "40536-1552",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "859-323-6494",
"PracticeLocationAddressFaxNumber": "859-257-2573",
"EnumerationDate": "07/21/2014",
"LastUpdateDate": "09/19/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "208G00000X",
"TaxonomyName": "Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician",
"LicenseNumber": "FL076",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "208G00000X",
"TaxonomyName": "Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician",
"LicenseNumber": "272964",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}