{
"Npi": {
"NPI": "1790926012",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ELSHERIF DDS A PROFESSIONAL CORPORATION",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4550 N LARK ELLEN AVE",
"SecondLineMailingAddress": "SUITE # 104",
"MailingAddressCityName": "COVINA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91722-3147",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-331-8041",
"MailingAddressFaxNumber": "626-331-4082",
"FirstLinePracticeLocationAddress": "4550 N LARK ELLEN AVE",
"SecondLinePracticeLocationAddress": "SUITE # 104",
"PracticeLocationAddressCityName": "COVINA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91722-3147",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "626-331-8041",
"PracticeLocationAddressFaxNumber": "626-331-4082",
"EnumerationDate": "03/17/2009",
"LastUpdateDate": "05/08/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ELSHERIF",
"AuthorizedOfficialFirstName": "ISMAIL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "626-331-8041",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "47883",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}