=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124170303
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLENDALE PROFESSIONAL HEARING CENTER,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 372 ARDEN AVE STE 101
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91203-1196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-243-0680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 372 ARDEN AVE STE 101
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91203-1196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-243-0680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOHN RUNDLES
-----------------------------------------------------
Credential | AUD
-----------------------------------------------------
Telephone | 818-243-0680
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AUD1257
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number | HA-2514
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------