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1902198575 NPI number — KYUNG-RAN TAE OT/L

NPI Number: 1902198575
Health Care Provider/Practitioner: KYUNG-RAN TAE OT/L

Information about “1902198575” NPI (KYUNG-RAN TAE OT/L) exists in 1902198575 in HTML format HTML  |  1902198575 in plain Text format TXT  |  1902198575 in PDF (Portable Document Format) PDF  |  1902198575 in an XML format XML  formats.

NPI Number : 1902198575 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1902198575",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TAE",
    "FirstName": "KYUNG-RAN",
    "MiddleName": null,
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "OT/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1324 S CITRUS AVE APT 6",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FULLERTON",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92833-4748",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "714-714-5597",
    "MailingAddressFaxNumber": "714-534-0004",
    "FirstLinePracticeLocationAddress": "9764 GARDEN GROVE BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GARDEN GROVE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92844-1615",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "714-534-0007",
    "PracticeLocationAddressFaxNumber": "714-534-0004",
    "EnumerationDate": "05/13/2011",
    "LastUpdateDate": "04/15/2021",
    "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": "225X00000X",
        "TaxonomyName": "Occupational Therapist",
        "LicenseNumber": "OT10347",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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