{
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"FirstLineMailingAddress": "PO BOX 72300",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHOENIX",
"MailingAddressStateName": "AZ",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "623-271-8666",
"MailingAddressFaxNumber": "623-271-8666",
"FirstLinePracticeLocationAddress": "14155 N 83RD AVE STE 138",
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"PracticeLocationAddressCityName": "PEORIA",
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"PracticeLocationAddressFaxNumber": "623-271-9229",
"EnumerationDate": "02/02/2018",
"LastUpdateDate": "04/27/2025",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "YEGANEH",
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"AuthorizedOfficialTelephoneNumber": "623-271-8666",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207VF0040X",
"TaxonomyName": "Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician",
"LicenseNumber": "38152",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}