=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689944092
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW AGE SYSTEMS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2012
-----------------------------------------------------
Last Update Date | 01/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2141 K ST NW LBBY 2
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20037-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-785-8704
-----------------------------------------------------
Fax | 202-464-0039
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2141 K ST NW LBBY 2
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20037-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-785-8704
-----------------------------------------------------
Fax | 202-464-0039
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. TED SEUNG-IL PARK
-----------------------------------------------------
Credential | BC-HIS
-----------------------------------------------------
Telephone | 202-785-8704
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AUD000077
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 02077
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------