{
"Npi": {
"NPI": "1831384981",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VALLEY CARE MEDICAL GROUP, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4021 THORNHILL WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MODESTO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95356-9351",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "209-241-6309",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "777 HAWKEYE AVE",
"SecondLinePracticeLocationAddress": "SUITE 3",
"PracticeLocationAddressCityName": "TURKLOCK",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95380",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "209-667-1718",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/12/2007",
"LastUpdateDate": "09/14/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LE",
"AuthorizedOfficialFirstName": "SUSAN",
"AuthorizedOfficialMiddleName": "PHI",
"AuthorizedOfficialTitle": "PHYSICIAN",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "209-241-6309",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "A89810",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}