Healthcare Provider Details

I. General information

NPI: 1265477871
Provider Name (Legal Business Name): VERMONT MEDICAL SUPPLY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2681 W OLYMPIC BLVD 101
LOS ANGELES CA
90006-2883
US

IV. Provider business mailing address

2681 W OLYMPIC BLVD 101
LOS ANGELES CA
90006-2883
US

V. Phone/Fax

Practice location:
  • Phone: 213-487-5695
  • Fax: 213-487-0203
Mailing address:
  • Phone: 213-487-5695
  • Fax: 213-487-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5735120001
License Number StateCA

VIII. Authorized Official

Name: BOK HEE CHA
Title or Position: PRESIDENT
Credential:
Phone: 213-487-5695