Healthcare Provider Details

I. General information

NPI: 1780083121
Provider Name (Legal Business Name): KIRSCH AUDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 WILSHIRE BLVD SUITE 450
SANTA MONICA CA
90403
US

IV. Provider business mailing address

2730 WILSHIRE BLVD SUITE 450
SANTA MONICA CA
90403
US

V. Phone/Fax

Practice location:
  • Phone: 310-586-5533
  • Fax: 310-560-1720
Mailing address:
  • Phone: 310-586-5533
  • Fax: 310-560-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberAU2111
License Number StateCA

VIII. Authorized Official

Name: DR. STEPHEN KIRSCH
Title or Position: OWNER
Credential: AU.D.
Phone: 310-586-5533