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1679095822 NPI number — CALEB P MASUDA M.S. L.AC

NPI Number: 1679095822
Health Care Provider/Practitioner: CALEB P MASUDA M.S. L.AC

Information about “1679095822” NPI (CALEB P MASUDA M.S. L.AC) exists in 1679095822 in HTML format HTML  |  1679095822 in plain Text format TXT  |  1679095822 in PDF (Portable Document Format) PDF  |  1679095822 in an XML format XML  formats.

NPI Number : 1679095822 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679095822",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MASUDA",
    "FirstName": "CALEB",
    "MiddleName": "P",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.S. L.AC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1166 BROADWAY STE R",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PLACERVILLE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95667-5745",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "530-303-8245",
    "MailingAddressFaxNumber": "855-345-9153",
    "FirstLinePracticeLocationAddress": "1166 BROADWAY STE R",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PLACERVILLE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95667-5745",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "530-303-8245",
    "PracticeLocationAddressFaxNumber": "855-345-9153",
    "EnumerationDate": "07/10/2017",
    "LastUpdateDate": "05/09/2025",
    "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": "171100000X",
        "TaxonomyName": "Acupuncturist",
        "LicenseNumber": "17564",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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