MEDICARE: MR. DANIEL R BROWN HEARING AID DISPENSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231HA2500X	Assistive Technology Supplier Audiologist	HA5095	CA

General Provider Information

NPI Number	:	1477601540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL R BROWN HEARING AID DISPENSE

Provider Business Mailing Address
First Line	:	4926 HOLLYWOOD BLVD
Second Line	:	SUITE B
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6102
Country	:	US
Telephone Number	:	323-540-3333
Fax Number	:	323-660-6034

Provider Business Practice Location Address
First Line	:	4926 HOLLYWOOD BLVD
Second Line	:	SUITE B
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6102
Country	:	US
Telephone Number	:	323-540-3333
Fax Number	:	323-660-6034

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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