Provider Demographics
NPI:1104118454
Name:AMERICAN HEARING & BALANCE CENTERS, INC.
Entity type:Organization
Organization Name:AMERICAN HEARING & BALANCE CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRIFKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-775-7795
Mailing Address - Street 1:703 PIER AVE
Mailing Address - Street 2:STE. 145
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3949
Mailing Address - Country:US
Mailing Address - Phone:310-625-5657
Mailing Address - Fax:310-818-5551
Practice Address - Street 1:10955 WESTMOOR DR
Practice Address - Street 2:STE. 400
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-2704
Practice Address - Country:US
Practice Address - Phone:303-483-8300
Practice Address - Fax:310-818-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COH51510207QG0300X
CA48648207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COH51510Medicare UPIN
CAA51131Medicare UPIN