{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "JEFFREY D YUSIM MD",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "950 E VISTA WAY",
"SecondLineMailingAddress": "SUITE C",
"MailingAddressCityName": "VISTA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92084-5252",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "760-295-7677",
"MailingAddressFaxNumber": "760-295-7690",
"FirstLinePracticeLocationAddress": "950 E VISTA WAY",
"SecondLinePracticeLocationAddress": "SUITE C",
"PracticeLocationAddressCityName": "VISTA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92084-5200",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-295-7677",
"PracticeLocationAddressFaxNumber": "760-295-7690",
"EnumerationDate": "10/15/2014",
"LastUpdateDate": "10/15/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "YUSIM",
"AuthorizedOfficialFirstName": "JEFFREY",
"AuthorizedOfficialMiddleName": "DAVID",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "760-295-7677",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "A45129",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}