{
"Npi": {
"NPI": "1699089771",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PARVEEN",
"FirstName": "UNKNOWN",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.D",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "PARVEEN",
"OtherFirstName": "PARVEEN",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MD",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "850 W RIO SALADO PKWY STE 201",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TEMPE",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85281-3812",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "804-808-3304",
"MailingAddressFaxNumber": "602-393-0293",
"FirstLinePracticeLocationAddress": "129 VISION PARK BLVD STE 109",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SHENANDOAH",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77384-3024",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "936-273-0836",
"PracticeLocationAddressFaxNumber": "936-321-2266",
"EnumerationDate": "08/02/2010",
"LastUpdateDate": "02/25/2025",
"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": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "MT196355",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208M00000X",
"TaxonomyName": "Hospitalist Physician",
"LicenseNumber": "47761",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207RN0300X",
"TaxonomyName": "Nephrology Physician",
"LicenseNumber": "S3038",
"LicenseNumberStateCode": "TX",
"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."
}
}
}
}