NPI Code Detail JSON Logo

1669569810 NPI number — P.S. ENTERPRISE, INC

NPI Number: 1669569810
Health Care Provider/Practitioner: P.S. ENTERPRISE, INC

Information about “1669569810” NPI (P.S. ENTERPRISE, INC) exists in 1669569810 in HTML format HTML  |  1669569810 in plain Text format TXT  |  1669569810 in PDF (Portable Document Format) PDF  |  1669569810 in an XML format XML  formats.

NPI Number : 1669569810 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669569810",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "P.S. ENTERPRISE, 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": "2300 HUNTINGTON DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN MARINO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91108-2641",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "626-287-9921",
    "MailingAddressFaxNumber": "626-285-0644",
    "FirstLinePracticeLocationAddress": "2300 HUNTINGTON DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN MARINO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91108-2641",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "626-287-9921",
    "PracticeLocationAddressFaxNumber": "626-285-0644",
    "EnumerationDate": "10/09/2006",
    "LastUpdateDate": "03/30/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LIM",
    "AuthorizedOfficialFirstName": "PHIC KAING",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PHRM D",
    "AuthorizedOfficialTelephoneNumber": "626-287-9921",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "3336C0004X",
          "TaxonomyName": "Compounding Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "332B00000X",
          "TaxonomyName": "Durable Medical Equipment & Medical Supplies",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "333600000X",
          "TaxonomyName": "Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "PHY45238",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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