{
"Npi": {
"NPI": "1831148469",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KIM-SHEPHERD",
"FirstName": "SO YOUN",
"MiddleName": "YOUN",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "FNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 7412011",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHICAGO",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60674-2011",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "314-362-9123",
"MailingAddressFaxNumber": "314-747-9160",
"FirstLinePracticeLocationAddress": "1225 GRAHAM RD",
"SecondLinePracticeLocationAddress": "DEPT EMERGENCY MEDICINE",
"PracticeLocationAddressCityName": "FLORISSANT",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63031-8012",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "314-362-9123",
"PracticeLocationAddressFaxNumber": "314-747-9160",
"EnumerationDate": "05/10/2006",
"LastUpdateDate": "07/14/2025",
"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": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "110189",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}