{
"Npi": {
"NPI": "1508371873",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GOVIND",
"FirstName": "PRATIK",
"MiddleName": "SHIRISH",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "MSHS, PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GOVINDJIE-GOVIND",
"OtherFirstName": "PRATIK",
"OtherMiddleName": "SHIRISH",
"OtherNamePrefix": "MR.",
"OtherNameSuffix": null,
"OtherCredential": "N/A",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PO BOX 276950",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SACRAMENTO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95827-6950",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": "925-482-8239",
"FirstLinePracticeLocationAddress": "795 EL CAMINO REAL",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PALO ALTO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94301-2302",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "650-853-2943",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/08/2017",
"LastUpdateDate": "01/13/2025",
"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": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "0110005879",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "C0006547",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "54756",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "PA031389",
"LicenseNumberStateCode": "DC",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}