MEDICARE: TAEYOUNG HEARING CENTER

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	237700000X	Hearing Instrument Specialist	HA2828	CA

General Provider Information

NPI Number	:	1598996969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAEYOUNG HEARING CENTER

Provider Business Mailing Address
First Line	:	1020 E. BASTANCHURY ROAD
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-2782
Country	:	US
Telephone Number	:	714-672-9445
Fax Number	:	714-672-9448

Provider Business Practice Location Address
First Line	:	1020 E. BASTANCHURY ROAD
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-2782
Country	:	US
Telephone Number	:	714-672-9445
Fax Number	:	714-672-9448

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KELVIN YOUNG KIM
Credential	:	AUDIOPROSTHOLOGIST/H
Telephone Number	:	714-672-9445

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	08/04/2009

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