Healthcare Provider Details

I. General information

NPI: 1386507952
Provider Name (Legal Business Name): PRABHJOT PAVAN MUDHAR AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 OLD NEWPORT BLVD #101
NEWPORT BEACH CA
92663
US

IV. Provider business mailing address

500 OLD NEWPORT BLVD #101
NEWPORT BEACH CA
92663
US

V. Phone/Fax

Practice location:
  • Phone: 949-274-8399
  • Fax: 949-642-2950
Mailing address:
  • Phone: 949-274-8399
  • Fax: 949-642-2950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number4125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: