{
"Npi": {
"NPI": "1629272026",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KAISER PERMANENTE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "10876 MARIETTA AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CULVER CITY",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90232-3714",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-836-7195",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5105 W GOLDLEAF CIR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LOS ANGELES",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90056-1269",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "323-298-3100",
"PracticeLocationAddressFaxNumber": "323-298-3119",
"EnumerationDate": "06/12/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DELORRELL",
"AuthorizedOfficialFirstName": "WALTER",
"AuthorizedOfficialMiddleName": "JOSEPH",
"AuthorizedOfficialTitle": "LICENSED PSYCHOTHERAPIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "MFT",
"AuthorizedOfficialTelephoneNumber": "323-298-3100",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302R00000X",
"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": "MFC 29835",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}