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General NPI Number Information
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NPI Number | 1578595641
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Entity Type | Organization
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Legal Business Name | KNC MEDICAL SUPPLY, INC
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 3931 W SLAUSON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90043-2976
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Country | US
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Telephone | 323-299-0837
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Fax |
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Provider Business Mailing Address
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Address Line | 4718 S MULLEN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90043-1718
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Country | US
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Telephone | 323-299-0837
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Fax | 323-299-0839
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | MR. OKEY OKAFOR
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Credential | N/A
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Telephone | 323-299-0837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | DME03143G
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | DME03143G
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | DME03143G
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License Number State | CA
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