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1679059257 NPI number — DARA SUON PHARM D

NPI Number: 1679059257
Health Care Provider/Practitioner: DARA SUON PHARM D

Information about “1679059257” NPI (DARA SUON PHARM D) exists in 1679059257 in HTML format HTML  |  1679059257 in plain Text format TXT  |  1679059257 in PDF (Portable Document Format) PDF  |  1679059257 in an XML format XML  formats.

NPI Number : 1679059257 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679059257",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SUON",
    "FirstName": "DARA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHARM D",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "13260 ALTA MESA RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GALT",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95632-8356",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "209-822-6311",
    "MailingAddressFaxNumber": "209-473-7377",
    "FirstLinePracticeLocationAddress": "4555 N PERSHING AVE STE 7",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "STOCKTON",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95207-6739",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "209-373-9629",
    "PracticeLocationAddressFaxNumber": "209-473-7377",
    "EnumerationDate": "07/17/2018",
    "LastUpdateDate": "07/17/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "47777",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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