{
"Npi": {
"NPI": "1922498302",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JERRY B MALLEUS, DDS INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "125 S BRAND BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN FERNANDO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91340-3304",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-365-6321",
"MailingAddressFaxNumber": "818-365-0011",
"FirstLinePracticeLocationAddress": "125 S BRAND BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAN FERNANDO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91340-3304",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-365-6321",
"PracticeLocationAddressFaxNumber": "818-365-0011",
"EnumerationDate": "01/23/2015",
"LastUpdateDate": "01/23/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MALLEUS",
"AuthorizedOfficialFirstName": "JERRY",
"AuthorizedOfficialMiddleName": "B",
"AuthorizedOfficialTitle": "PRES.",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "818-832-5102",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "24826",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}