{
"Npi": {
"NPI": "1689288649",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "LEE",
"FirstName": "JAE JEONG",
"MiddleName": "GLORIA",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DAOM",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "LEE",
"OtherFirstName": "GLORIA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "32 LORRAINE METCALF RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FRANKLIN",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "02038-3234",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "860-460-9074",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "136A W MAIN RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MIDDLETOWN",
"PracticeLocationAddressStateName": "RI",
"PracticeLocationAddressPostalCode": "02842-4937",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "401-862-4894",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/07/2020",
"LastUpdateDate": "09/07/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "133N00000X",
"TaxonomyName": "Nutritionist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "171100000X",
"TaxonomyName": "Acupuncturist",
"LicenseNumber": "DA00468",
"LicenseNumberStateCode": "RI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}