Provider Demographics
NPI:1770917049
Name:GIBSON, KEIKO YVONNE (AUD)
Entity type:Individual
Prefix:
First Name:KEIKO
Middle Name:YVONNE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 GARDEN GROVE BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-8234
Mailing Address - Country:US
Mailing Address - Phone:714-898-5732
Mailing Address - Fax:714-901-4058
Practice Address - Street 1:1127 WILSHIRE BLVD
Practice Address - Street 2:STE 1202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4003
Practice Address - Country:US
Practice Address - Phone:714-898-5732
Practice Address - Fax:714-901-4058
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2933237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter