{
"Npi": {
"NPI": "1992330781",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "NGUYEN",
"FirstName": "ANNIE",
"MiddleName": "PHUONG THAO DINH",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PHARM.D., BCPS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "NGUYEN",
"OtherFirstName": "PHUONG",
"OtherMiddleName": "THAO DINH",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1604 MAXWELL AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROYAL OAK",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48067-1267",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "858-201-9905",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "22101 MOROSS RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DETROIT",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48236-2148",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "313-343-3760",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/12/2020",
"LastUpdateDate": "03/12/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "5302044687",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "76450",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}