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General NPI Number Information
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NPI Number | 1518996479
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Entity Type | Organization
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Legal Business Name | KINGDOM MEDICAL DISTRIBUTORS SUPPLY INC
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1256 N EUCLID ST SUITE B
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City | ANAHEIM
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State | CA
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Zip | 92801-1928
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Country | US
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Telephone | 714-535-7844
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Fax | 714-535-7833
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Provider Business Mailing Address
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Address Line | 1256 N EUCLID ST SUITE B
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City | ANAHEIM
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State | CA
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Zip | 92801-1928
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Country | US
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Telephone | 714-535-7844
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Fax | 714-535-7833
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. DONATUS BERNARD INYANG
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Credential | RCP
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Telephone | 714-535-7844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | RCP 10503
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License Number State | CA
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