{
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"LastName": null,
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"FirstLineMailingAddress": "601 UNIVERSITY AVE W",
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"MailingAddressCityName": "SAINT PAUL",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "651-600-3988",
"MailingAddressFaxNumber": "651-788-9068",
"FirstLinePracticeLocationAddress": "601 UNIVERSITY AVE W",
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"PracticeLocationAddressCityName": "SAINT PAUL",
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"EnumerationDate": "08/03/2016",
"LastUpdateDate": "08/24/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NGUYEN",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialTelephoneNumber": "651-600-3988",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336C0004X",
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"PrimaryTaxonomySwitch": "N"
},
{
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}