Provider Demographics
NPI:1235353194
Name:AVALON HEARING AID CENTER, INC
Entity Type:Organization
Organization Name:AVALON HEARING AID CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-483-9064
Mailing Address - Street 1:2620 HURLEY WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-3789
Mailing Address - Country:US
Mailing Address - Phone:916-483-9064
Mailing Address - Fax:916-483-3514
Practice Address - Street 1:2620 HURLEY WAY
Practice Address - Street 2:SUITE B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-3789
Practice Address - Country:US
Practice Address - Phone:916-483-9064
Practice Address - Fax:916-483-3514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1640231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU1640OtherSTATE LICENSE