=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508983677
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNION AUDIOLOGY AND HEARING AID SERVICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14435 SHERMAN WAY SUITE 207
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-994-8927
-----------------------------------------------------
Fax | 818-994-0364
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14435 SHERMAN WAY SUITE 207
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-994-8927
-----------------------------------------------------
Fax | 818-994-0364
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUDIOLOGIST HEARING AID DISPENSER
-----------------------------------------------------
Name | MR. BRIAN DURAND FORQUER
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 818-994-8927
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AU482
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number | HA2232
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------