{
"Npi": {
"NPI": "1801306535",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KAA DENTAL LLC",
"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": "8100 RANDOLPH WAY APT 202",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ELLICOTT CITY",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21043-4790",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "443-902-1256",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "10007 STEDWICK RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MONTGOMERY VILLAGE",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20886-3710",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "240-288-9999",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/08/2017",
"LastUpdateDate": "12/21/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NAYUDU",
"AuthorizedOfficialFirstName": "KIRAN",
"AuthorizedOfficialMiddleName": "VENKATA",
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "240-288-9999",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "15464",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}