Provider Demographics
NPI:1194862219
Name:MALAN, JOHN DANIEL (AUD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DANIEL
Last Name:MALAN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 SIMI TOWN CENTER WAY STE 3
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-8408
Mailing Address - Country:US
Mailing Address - Phone:805-579-9324
Mailing Address - Fax:805-579-9647
Practice Address - Street 1:1717 SIMI TOWN CENTER WAY STE 3
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-8408
Practice Address - Country:US
Practice Address - Phone:805-579-9324
Practice Address - Fax:805-579-9647
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1728237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB219328OtherMEDICARE
CAGM441ZOtherMEDICARE PTAN