Healthcare Provider Details

I. General information

NPI: 1558917328
Provider Name (Legal Business Name): TAEYOUNG CELINA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 E ROWLAND STREET
COVINA CA
91723-3049
US

IV. Provider business mailing address

165 E. ROWLAND STREET
COVINA CA
91723-3049
US

V. Phone/Fax

Practice location:
  • Phone: 714-672-9445
  • Fax: 714-972-9448
Mailing address:
  • Phone: 714-672-9445
  • Fax: 714-672-9448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER KIM
Title or Position: CEO
Credential:
Phone: 714-672-9445