Provider Demographics
NPI:1831471218
Name:ACTIVE HEARING INC
Entity Type:Organization
Organization Name:ACTIVE HEARING INC
Other - Org Name:SONUS SF0016
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EHSAN
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:KAMALVAND
Authorized Official - Suffix:
Authorized Official - Credentials:HAD
Authorized Official - Phone:770-527-5223
Mailing Address - Street 1:260 MAIN ST
Mailing Address - Street 2:STE F
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1778
Mailing Address - Country:US
Mailing Address - Phone:650-366-2900
Mailing Address - Fax:650-366-2908
Practice Address - Street 1:260 MAIN ST
Practice Address - Street 2:STE F
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1778
Practice Address - Country:US
Practice Address - Phone:650-366-2900
Practice Address - Fax:650-366-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA6014237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty