Basic Information
| Provider Information | |||||||||
| NPI: | 1083123129 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABOLHOSSEINI | ||||||||
| FirstName: | KASRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30642 MIRANDELA LN | ||||||||
| Address2: | |||||||||
| City: | LAGUNA NIGUEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926772347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495790957 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12791 NEWPORT AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927802785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147316549 | ||||||||
| FaxNumber: | 7147305372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2017 | ||||||||
| LastUpdateDate: | 09/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AU3255 | CA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.