Healthcare Provider Details

I. General information

NPI: 1144151903
Provider Name (Legal Business Name): KOLTON SORENSEN HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 S BELL BLVD
CEDAR PARK TX
78613-3972
US

IV. Provider business mailing address

105 CAMELLIA AVE
ORANGE TX
77630-4657
US

V. Phone/Fax

Practice location:
  • Phone: 512-258-8111
  • Fax: 409-883-6146
Mailing address:
  • Phone: 409-883-3010
  • Fax: 409-883-6146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number81222
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: