{
"Npi": {
"NPI": "1538052295",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "TINGEY",
"FirstName": "KIAN",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "TINGEY",
"OtherFirstName": "KIAN",
"OtherMiddleName": null,
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "D.M.D",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "7022 W MAYA WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PEORIA",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85383-5564",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "425-985-6003",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8345 W THUNDERBIRD RD STE B100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PEORIA",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85381-3668",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "602-943-3700",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/02/2025",
"LastUpdateDate": "06/02/2025",
"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": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "D012512",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}