Provider Demographics
NPI:1235204751
Name:BILLHEIMER, KENNETH DEAN (AUD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DEAN
Last Name:BILLHEIMER
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 1:4460 BLACK AVE STE F
Mailing Address - Street 2:SUITE F
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6139
Mailing Address - Country:US
Mailing Address - Phone:925-484-3507
Mailing Address - Fax:925-484-3556
Practice Address - Street 1:4460 BLACK AVE STE F
Practice Address - Street 2:SUITE F
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6139
Practice Address - Country:US
Practice Address - Phone:925-484-3507
Practice Address - Fax:925-484-3556
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU746231H00000X, 231HA2400X, 237600000X, 237700000X, 231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA931228205OtherFEDERAL TAX ID
CA931228205OtherFEDERAL TAX ID