=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659609683
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED HEARING SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2009
-----------------------------------------------------
Last Update Date | 12/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 62 CORPORATE PARK SUITE 112
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92606-3122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-250-9695
-----------------------------------------------------
Fax | 949-250-9698
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 62 CORPORATE PARK SUITE 112
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92606-3122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-250-9695
-----------------------------------------------------
Fax | 949-250-9698
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/AUDIOLOGIST
-----------------------------------------------------
Name | JENNIFER HATZKILSON
-----------------------------------------------------
Credential | M.A.
-----------------------------------------------------
Telephone | 949-250-9695
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AU1235
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------