Provider Demographics
NPI:1760526503
Name:AMERICAN HEARING AND BALANCE CORPORATION
Entity Type:Organization
Organization Name:AMERICAN HEARING AND BALANCE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:310-677-1168
Mailing Address - Street 1:6229 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3901
Mailing Address - Country:US
Mailing Address - Phone:310-677-1168
Mailing Address - Fax:310-377-0203
Practice Address - Street 1:6229 W 87TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3901
Practice Address - Country:US
Practice Address - Phone:310-677-1168
Practice Address - Fax:310-377-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1216237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGAU000830Medicaid
CA4309846OtherAETNA PROVIDER NUMBER
CAGAU000830Medicaid