Provider Demographics
NPI:1013082676
Name:YOSHIO J FURUYA MACCCA AUD CORP
Entity Type:Organization
Organization Name:YOSHIO J FURUYA MACCCA AUD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YOSHIO
Authorized Official - Middle Name:JIMMY
Authorized Official - Last Name:FURUYA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:626-795-0679
Mailing Address - Street 1:960 E GREEN STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2401
Mailing Address - Country:US
Mailing Address - Phone:626-795-0679
Mailing Address - Fax:626-795-5822
Practice Address - Street 1:960 E GREEN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2401
Practice Address - Country:US
Practice Address - Phone:626-795-0679
Practice Address - Fax:626-795-5822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU269231H00000X
CAHA1097332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA1097OtherLICENSE FOR HEARING AID D
CAZZZ71175ZMedicaid
CAZZZ71175ZMedicaid