Provider Demographics
NPI:1508983677
Name:UNION AUDIOLOGY AND HEARING AID SERVICE INC
Entity Type:Organization
Organization Name:UNION AUDIOLOGY AND HEARING AID SERVICE INC
Other - Org Name:BRIAN D FORQUER MS
Other - Org Type:Other Name
Authorized Official - Title/Position:AUDIOLOGIST HEARING AID DISPENSER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DURAND
Authorized Official - Last Name:FORQUER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:818-994-8927
Mailing Address - Street 1:14435 SHERMAN WAY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405
Mailing Address - Country:US
Mailing Address - Phone:818-994-8927
Mailing Address - Fax:818-994-0364
Practice Address - Street 1:14435 SHERMAN WAY
Practice Address - Street 2:SUITE 207
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405
Practice Address - Country:US
Practice Address - Phone:818-994-8927
Practice Address - Fax:818-994-0364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU482231H00000X
CAHA2232237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0004820Medicaid
AUD482Medicare ID - Type Unspecified
CAAU0004820Medicaid