{
"Npi": {
"NPI": "1710432174",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SHAKUR",
"FirstName": "KIMBERLY",
"MiddleName": "HOLDEN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PHARMD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6320 GREEN VALLEY CIR",
"SecondLineMailingAddress": "APT 200",
"MailingAddressCityName": "CULVER CITY",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90230-7078",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-514-5582",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "757 WESTWOOD PLZ",
"SecondLinePracticeLocationAddress": "B504A",
"PracticeLocationAddressCityName": "LOS ANGELES",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90095-8358",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-267-7721",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/15/2016",
"LastUpdateDate": "08/15/2016",
"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": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "62797",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "PS40114",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "26380",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "PH3725",
"LicenseNumberStateCode": "HI",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}