{
"Npi": {
"NPI": "1982043428",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THE ADVANCED SURGICAL INSTITUTE OF RANCHO CUCAMONGA, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8112 MILLIKEN AVE",
"SecondLineMailingAddress": "SUITE 202",
"MailingAddressCityName": "RANCHO CUCAMONGA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91730-7471",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-373-4380",
"MailingAddressFaxNumber": "909-373-4388",
"FirstLinePracticeLocationAddress": "19671 BEACH BLVD",
"SecondLinePracticeLocationAddress": "SUITE 321",
"PracticeLocationAddressCityName": "HUNTINGTON BEACH",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92648-5901",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-969-2520",
"PracticeLocationAddressFaxNumber": "714-969-7480",
"EnumerationDate": "06/18/2013",
"LastUpdateDate": "06/18/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AL-HAKEEM",
"AuthorizedOfficialFirstName": "MAZIN",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "MEDICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "909-373-4380",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}