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1730764192 NPI number — DAVID C.D. OH PMHNP - BC

NPI Number: 1730764192
Health Care Provider/Practitioner: DAVID C.D. OH PMHNP - BC

Information about “1730764192” NPI (DAVID C.D. OH PMHNP - BC) exists in 1730764192 in HTML format HTML  |  1730764192 in plain Text format TXT  |  1730764192 in PDF (Portable Document Format) PDF  |  1730764192 in an XML format XML  formats.

NPI Number : 1730764192 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730764192",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "OH",
    "FirstName": "DAVID",
    "MiddleName": "C.D.",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PMHNP - BC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4040 BARRANCA PKWY STE 260",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "IRVINE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92604-4780",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "925-282-1778",
    "MailingAddressFaxNumber": "415-296-5299",
    "FirstLinePracticeLocationAddress": "4040 BARRANCA PKWY STE 260",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "IRVINE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92604-4780",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "925-282-1778",
    "PracticeLocationAddressFaxNumber": "415-296-5299",
    "EnumerationDate": "03/16/2021",
    "LastUpdateDate": "08/06/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "811664",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "95015845",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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