MEDICARE: KEIKO YVONNE GIBSON A.U.D

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	237600000X	Audiologist-Hearing Aid Fitter	2933	CA

General Provider Information

NPI Number	:	1770917049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEIKO YVONNE GIBSON A.U.D

Provider Business Mailing Address
First Line	:	5555 GARDEN GROVE BLVD
Second Line	:	STE 200
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-8234
Country	:	US
Telephone Number	:	714-898-5732
Fax Number	:	714-901-4058

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD
Second Line	:	STE 1202
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4003
Country	:	US
Telephone Number	:	714-898-5732
Fax Number	:	714-901-4058

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

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	11/06/2018

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