=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952770810
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNION HEARING AID CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2015
-----------------------------------------------------
Last Update Date | 09/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5615 WHITTIER BLVD STE E
-----------------------------------------------------
City | COMMERCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90022-4128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-721-6424
-----------------------------------------------------
Fax | 323-721-1815
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5615 WHITTIER BLVD STE E
-----------------------------------------------------
City | COMMERCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90022-4128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-721-6424
-----------------------------------------------------
Fax | 323-721-1815
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DISPENSING AUDIOLOGIST
-----------------------------------------------------
Name | SIMON JAMES DEVILLY
-----------------------------------------------------
Credential | M.A.
-----------------------------------------------------
Telephone | 323-721-6424
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number | AU2040
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------