Healthcare Provider Details

I. General information

NPI: 1962555938
Provider Name (Legal Business Name): KINGDOM MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2007
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 IRVING ST
SAN FRANCISCO CA
94122-1818
US

IV. Provider business mailing address

1812 IRVING ST
SAN FRANCISCO CA
94122-1818
US

V. Phone/Fax

Practice location:
  • Phone: 415-751-0628
  • Fax: 415-751-0619
Mailing address:
  • Phone: 415-751-0628
  • Fax: 415-751-0619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number46267
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number46267
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number46267
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number46267
License Number StateCA

VIII. Authorized Official

Name: MRS. CHRISTINE JIN ZHAO
Title or Position: PRESIDENT & CEO
Credential:
Phone: 415-751-0628