{
"Npi": {
"NPI": "1518840420",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JO",
"FirstName": "JAE KYUNG",
"MiddleName": null,
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "ACUPUNCTURIST",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "345, SONGPA-DAERO, SONGPA-GU",
"SecondLineMailingAddress": "HELIO CITY APTS #202-2001",
"MailingAddressCityName": "SEOUL",
"MailingAddressStateName": "SEOUL",
"MailingAddressPostalCode": "05698",
"MailingAddressCountryCode": "KR",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "345, SONGPA-DAERO, SONGPA-GU",
"SecondLinePracticeLocationAddress": "HELIO CITY APTS #202-2001",
"PracticeLocationAddressCityName": "SEOUL",
"PracticeLocationAddressStateName": "SEOUL",
"PracticeLocationAddressPostalCode": "05698",
"PracticeLocationAddressCountryCode": "KR",
"PracticeLocationAddressTelephoneNumber": "213-285-7685",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/29/2025",
"LastUpdateDate": "07/29/2025",
"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": "171100000X",
"TaxonomyName": "Acupuncturist",
"LicenseNumber": "16338",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}