Basic Information
| Provider Information | |||||||||
| NPI: | 1912061870 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHA HEARING AID CENTER, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHA HEARING AID CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1425 E LINCOLN AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928052209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147764366 | ||||||||
| FaxNumber: | 7147760899 | ||||||||
| Practice Location | |||||||||
| Address1: | 1425 E LINCOLN AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928052209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147764366 | ||||||||
| FaxNumber: | 7147760899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WHITAKER | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7147764366 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HA3285 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | ZZZ70527Z | 05 | CA | MEDICAID |