Provider Demographics
NPI:1831369552
Name:ORTEGA, KIM KUCENAS (AUD)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:KUCENAS
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:N
Other - Last Name:KUCENAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:13121 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-4302
Mailing Address - Country:US
Mailing Address - Phone:562-698-0581
Mailing Address - Fax:
Practice Address - Street 1:13121 PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4302
Practice Address - Country:US
Practice Address - Phone:562-698-0581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 7270237700000X
CAAU2551231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist