MEDICARE: AKANIFIOK CLEMENT INYANG FRIENDLY MEDICAL SUPPLY

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	332B00000X	Durable Medical Equipment & Medical Supplies	101806	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548379514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AKANIFIOK CLEMENT INYANG FRIENDLY MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	2130 HUNTINGTON DR STE 313
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4980
Country	:	US
Telephone Number	:	626-799-0868
Fax Number	:	626-799-8848

Provider Business Practice Location Address
First Line	:	2130 HUNTINGTON DR STE 313
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4980
Country	:	US
Telephone Number	:	626-799-0868
Fax Number	:	626-799-8848

Authorized Official
Title or Position	:	OWNER
Name	:	AKANIFIOK CLEMENT INYANG
Credential	:
Telephone Number	:	626-799-0868

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	05/11/2011

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