{
"Npi": {
"NPI": "1780020677",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "UNIVERSITY PLACE SMILES PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3670 BRIDGEPORT WAY W",
"SecondLineMailingAddress": "UNIT B",
"MailingAddressCityName": "UNIVERSITY PLACE",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98466-4413",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "253-212-3430",
"MailingAddressFaxNumber": "253-212-3288",
"FirstLinePracticeLocationAddress": "3670 BRIDGEPORT WAY W",
"SecondLinePracticeLocationAddress": "UNIT B",
"PracticeLocationAddressCityName": "UNIVERSITY PLACE",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98466-4413",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "253-212-3430",
"PracticeLocationAddressFaxNumber": "253-212-3288",
"EnumerationDate": "05/17/2013",
"LastUpdateDate": "09/07/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PARK",
"AuthorizedOfficialFirstName": "YONG",
"AuthorizedOfficialMiddleName": "K",
"AuthorizedOfficialTitle": "OWNER/DENTIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "253-212-3430",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "DE0009186",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}