1013082676 NPI number — YOSHIO J FURUYA MACCCA AUD CORP

Table of content: (NPI 1013082676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013082676 NPI number — YOSHIO J FURUYA MACCCA AUD CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOSHIO J FURUYA MACCCA AUD CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013082676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
960 E GREEN STREET
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91106-2401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-795-0679
Provider Business Mailing Address Fax Number:
626-795-5822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
960 E GREEN ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91106-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-795-0679
Provider Business Practice Location Address Fax Number:
626-795-5822
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FURUYA
Authorized Official First Name:
YOSHIO
Authorized Official Middle Name:
JIMMY
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
626-795-0679

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X , with the licence number:  HA1097 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: AU269 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HA1097 . This is a "LICENSE FOR HEARING AID D" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ71175Z , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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