{
"Npi": {
"NPI": "1770747768",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BANG",
"FirstName": "MARY",
"MiddleName": "AN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PHARM.D., BCOP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "AN",
"OtherFirstName": "MARY",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "20629 W CHESTNUT CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PORTER RANCH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91326-4949",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-871-6305",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "12254 BELLFLOWER BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DOWNEY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90242-2804",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-871-6305",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/18/2008",
"LastUpdateDate": "05/06/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "60125",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}