{
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"EIN": null,
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"IsOrgSubpart": "N",
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"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "16060 VENTURA BLVD STE 505-110",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ENCINO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91436-2761",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "16060 VENTURA BLVD SUITE 110-505",
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"PracticeLocationAddressCityName": "ENCINO",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-989-3650",
"PracticeLocationAddressFaxNumber": "818-989-3649",
"EnumerationDate": "01/22/2014",
"LastUpdateDate": "01/22/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ZASS",
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"AuthorizedOfficialTitle": "CEO",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "818-989-3650",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Private Vehicle",
"LicenseNumber": "000000000",
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}