{
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"FirstLineMailingAddress": "657 OAK GROVE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MENLO PARK",
"MailingAddressStateName": "CA",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "151 FOREST AVE",
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"PracticeLocationAddressCityName": "PALO ALTO",
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"EnumerationDate": "11/07/2022",
"LastUpdateDate": "12/30/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HOUSE",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "650-213-7062",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207YS0123X",
"TaxonomyName": "Facial Plastic Surgery Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}