Provider Demographics
NPI:1558580100
Name:MUHURY, ANJAN - (HEARING AID DISPENSE)
Entity Type:Individual
Prefix:MR
First Name:ANJAN
Middle Name:-
Last Name:MUHURY
Suffix:
Gender:M
Credentials:HEARING AID DISPENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-5301
Mailing Address - Country:US
Mailing Address - Phone:562-433-6701
Mailing Address - Fax:562-434-9461
Practice Address - Street 1:3740 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-5301
Practice Address - Country:US
Practice Address - Phone:562-433-6701
Practice Address - Fax:562-434-9461
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA3723174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0037230Medicaid