Provider Demographics
NPI:1700312337
Name:KJ HEARING LLC
Entity Type:Organization
Organization Name:KJ HEARING LLC
Other - Org Name:JASA HEARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / HIS
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JASA
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:515-499-4302
Mailing Address - Street 1:116 1ST AVE N
Mailing Address - Street 2:STE C
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1425
Mailing Address - Country:US
Mailing Address - Phone:515-499-4302
Mailing Address - Fax:
Practice Address - Street 1:116 1ST AVE N
Practice Address - Street 2:STE C
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1425
Practice Address - Country:US
Practice Address - Phone:515-499-4302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000944305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No305R00000XManaged Care OrganizationsPreferred Provider Organization