{
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"FirstLineMailingAddress": "3350 E BIRCH ST",
"SecondLineMailingAddress": "SUITE 105",
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"MailingAddressPostalCode": "92821-6264",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-992-0850",
"MailingAddressFaxNumber": "714-526-8271",
"FirstLinePracticeLocationAddress": "5528 E LA PALMA AVE STE 4A",
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"PracticeLocationAddressCityName": "ANAHEIM",
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"PracticeLocationAddressTelephoneNumber": "714-993-2000",
"PracticeLocationAddressFaxNumber": "714-524-4216",
"EnumerationDate": "03/20/2006",
"LastUpdateDate": "09/05/2024",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHAN",
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"AuthorizedOfficialTelephoneNumber": "714-526-2241",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2085R0202X",
"TaxonomyName": "Diagnostic Radiology Physician",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}