{
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"FirstLineMailingAddress": "350 2ND ST",
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"MailingAddressPostalCode": "94022-3695",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "350 2ND ST",
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"PracticeLocationAddressFaxNumber": "650-949-0951",
"EnumerationDate": "04/20/2015",
"LastUpdateDate": "04/20/2015",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HENDERSON",
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"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "D.D.S.",
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"Taxonomies": {
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{
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{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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{
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},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
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}
]
}
}
}