Healthcare Provider Details

I. General information

NPI: 1255049953
Provider Name (Legal Business Name): PHILIP A SHURA JR. AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 WILSHIRE BLVD STE 309
LOS ANGELES CA
90048-5723
US

IV. Provider business mailing address

6333 WILSHIRE BLVD
LOS ANGELES CA
90048-5702
US

V. Phone/Fax

Practice location:
  • Phone: 323-651-5107
  • Fax: 323-651-4169
Mailing address:
  • Phone: 323-651-5107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU3760
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAU3760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: