=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306001151
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MNANNA WORLD,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2008
-----------------------------------------------------
Last Update Date | 07/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11619 DUENDA RD
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-487-7800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11619 DUENDA RD
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92127-1110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-487-7800
-----------------------------------------------------
Fax | 858-487-0092
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. SUN J LEE
-----------------------------------------------------
Credential | C.PED
-----------------------------------------------------
Telephone | 858-487-7800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------