{
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"FirstLineMailingAddress": "PO BOX 1768",
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"MailingAddressCityName": "KAILUA",
"MailingAddressStateName": "HI",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "808-262-2099",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "415 ULUNIU ST STE D",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/13/2007",
"LastUpdateDate": "03/03/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GLENN",
"AuthorizedOfficialFirstName": "DEBORAH",
"AuthorizedOfficialMiddleName": "S.I.",
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"AuthorizedOfficialCredential": "D.C.",
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"Taxonomies": {
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"TaxonomyName": "Clinic/Center",
"LicenseNumber": "DC 907",
"LicenseNumberStateCode": "HI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}