{
"Npi": {
"NPI": "1972012227",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PLANET HEALTH INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2001 E 4TH ST STE 112",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SANTA ANA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92705-3916",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-541-3900",
"MailingAddressFaxNumber": "714-541-3901",
"FirstLinePracticeLocationAddress": "2001 E 4TH ST STE 112",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SANTA ANA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92705-3916",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-541-3900",
"PracticeLocationAddressFaxNumber": "714-541-3901",
"EnumerationDate": "09/29/2017",
"LastUpdateDate": "11/24/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHAH",
"AuthorizedOfficialFirstName": "KRINABEN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT/CEO/TREASURER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "949-568-7886",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHY55777",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}