{
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"FirstLineMailingAddress": "1001 BANNOCK ST STE 449",
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"FirstLinePracticeLocationAddress": "1001 BANNOCK ST STE 449",
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"EnumerationDate": "11/07/2024",
"LastUpdateDate": "11/07/2024",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "KIM",
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"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}