{
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"OrgName": "UCLA SCHOOL OF DENTISTRY ESTHETIC",
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"FirstLineMailingAddress": "10833 LE CONTE AVE.",
"SecondLineMailingAddress": "CHS 33-064",
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"FirstLinePracticeLocationAddress": "10833 LE CONTE AVE RM 33-064A",
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"EnumerationDate": "02/15/2007",
"LastUpdateDate": "10/09/2025",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KIM",
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"AuthorizedOfficialCredential": "DDS",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Dentistry",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}