{
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"NamePrefix": null,
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"FirstLineMailingAddress": "5801 S SAN PEDRO ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90011-5323",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "323-238-0445",
"MailingAddressFaxNumber": "323-230-6271",
"FirstLinePracticeLocationAddress": "5801 S SAN PEDRO ST",
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"PracticeLocationAddressCityName": "LOS ANGELES",
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"EnumerationDate": "10/18/2012",
"LastUpdateDate": "10/18/2012",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRANCH",
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"AuthorizedOfficialCredential": "MS",
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"Taxonomies": {
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"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}