{
"Npi": {
"NPI": "1679271670",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "AGYEKUM",
"FirstName": "AUGUSTINE",
"MiddleName": "KWAKU",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "932 7TH ST APT 4",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SANTA MONICA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90403-2735",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "215-779-0805",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1815 BLACKBERRY LN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GLADWYNE",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19035-1101",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "877-225-0316",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/20/2023",
"LastUpdateDate": "02/20/2023",
"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": "305S00000X",
"TaxonomyName": "Point of Service",
"LicenseNumber": null,
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}