{
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"ParentOrgLBN": null,
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"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "528 NO PALM AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ONTARIO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91762-3218",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-986-9635",
"MailingAddressFaxNumber": "909-391-5873",
"FirstLinePracticeLocationAddress": "528 NO PALM AVE",
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"PracticeLocationAddressCityName": "ONTARIO",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-986-9635",
"PracticeLocationAddressFaxNumber": "909-391-5873",
"EnumerationDate": "08/04/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JONES",
"AuthorizedOfficialFirstName": "GARY",
"AuthorizedOfficialMiddleName": "M",
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"AuthorizedOfficialCredential": "HIS",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "237700000X",
"TaxonomyName": "Hearing Instrument Specialist",
"LicenseNumber": "HA3682",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}