{
"Npi": {
"NPI": "1639345879",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TIM WANG DDS, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "46921 WARM SPRINGS BLVD STE 203",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FREMONT",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94539-7934",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "510-792-7888",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "46921 WARM SPRINGS BLVD STE 203",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FREMONT",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94539-7934",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "510-792-7888",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/07/2008",
"LastUpdateDate": "07/18/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WANG",
"AuthorizedOfficialFirstName": "TIM",
"AuthorizedOfficialMiddleName": "TING- CHUN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "510-792-7888",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "48405",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}