Healthcare Provider Details

I. General information

NPI: 1154320760
Provider Name (Legal Business Name): MARSDEN SHOE CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 07/21/2022
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 GREENLEAF AVE
WHITTIER CA
90601-4110
US

IV. Provider business mailing address

6707 GREENLEAF AVE
WHITTIER CA
90601-4110
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-7281
  • Fax: 562-693-0462
Mailing address:
  • Phone: 562-698-7281
  • Fax: 562-693-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAN HWANG
Title or Position: CEO
Credential: CERTIFIED PEDORTHIST
Phone: 562-698-7281