{
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"FirstLineMailingAddress": "11121 PALMWOOD DR",
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"MailingAddressTelephoneNumber": "714-788-5566",
"MailingAddressFaxNumber": "714-442-3946",
"FirstLinePracticeLocationAddress": "8915 WESTMINSTER AVE",
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"EnumerationDate": "07/26/2025",
"LastUpdateDate": "09/22/2025",
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"GenderCode": null,
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"AuthorizedOfficialLastName": "PHAM",
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"Taxonomies": {
"Taxonomy": [
{
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}