Provider Demographics
NPI:1053656710
Name:CUNNINGHAM, EDMUND DON
Entity Type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:DON
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18401 BURBANK BLVD
Mailing Address - Street 2:SUITE #106
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2822
Mailing Address - Country:US
Mailing Address - Phone:818-341-5407
Mailing Address - Fax:818-341-4105
Practice Address - Street 1:18401 BURBANK BLVD
Practice Address - Street 2:SUITE #106
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2822
Practice Address - Country:US
Practice Address - Phone:818-341-5407
Practice Address - Fax:818-341-4105
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7051237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist