{
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"FirstLineMailingAddress": "715 SOUTHPOINT BLVD",
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"MailingAddressFaxNumber": "707-778-6068",
"FirstLinePracticeLocationAddress": "715 SOUTHPOINT BLVD",
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"PracticeLocationAddressTelephoneNumber": "707-778-6019",
"PracticeLocationAddressFaxNumber": "707-778-6068",
"EnumerationDate": "05/03/2007",
"LastUpdateDate": "04/13/2015",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PARK",
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"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}