=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265477871
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VERMONT MEDICAL SUPPLY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2006
-----------------------------------------------------
Last Update Date | 07/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2681 W OLYMPIC BLVD 101
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90006-2883
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-487-5695
-----------------------------------------------------
Fax | 213-487-0203
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2681 W OLYMPIC BLVD 101
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90006-2883
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-487-5695
-----------------------------------------------------
Fax | 213-487-0203
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BOK HEE CHA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-487-5695
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 5735120001
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------