=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407189475
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | S AND J MEDICAL SUPPLY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2009
-----------------------------------------------------
Last Update Date | 11/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1329 N LA BREA AVE
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90302-1216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-412-2000
-----------------------------------------------------
Fax | 310-412-2020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1329 N LA BREA AVE
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90302-1216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-412-2000
-----------------------------------------------------
Fax | 310-412-2020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | OGANES BALIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-559-1211
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 101-272660
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------