{
"Npi": {
"NPI": "1760606537",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CENTER FOR INTERVENTIONAL SPINE, A MEDICAL CORPORATION",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2424 ARDEN WAY STE 301",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SACRAMENTO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95825-2464",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "916-977-0741",
"MailingAddressFaxNumber": "916-977-0547",
"FirstLinePracticeLocationAddress": "2424 ARDEN WAY STE 301",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SACRAMENTO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95825-2464",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "916-977-0741",
"PracticeLocationAddressFaxNumber": "916-977-0547",
"EnumerationDate": "04/12/2007",
"LastUpdateDate": "03/31/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHIN",
"AuthorizedOfficialFirstName": "CARL",
"AuthorizedOfficialMiddleName": "HYUN-GEOL",
"AuthorizedOfficialTitle": "MEDICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "916-977-0741",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2081P2900X",
"TaxonomyName": "Pain Medicine (Physical Medicine & Rehabilitation) Physician",
"LicenseNumber": "A60900",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2081P2900X",
"TaxonomyName": "Pain Medicine (Physical Medicine & Rehabilitation) Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208VP0014X",
"TaxonomyName": "Interventional Pain Medicine Physician",
"LicenseNumber": "A60900",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332900000X",
"TaxonomyName": "Non-Pharmacy Dispensing Site",
"LicenseNumber": "A60900",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208VP0014X",
"TaxonomyName": "Interventional Pain Medicine Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
]
}
}
}