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General NPI Number Information
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NPI Number | 1659537595
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Entity Type | Organization
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Legal Business Name | MED LIFE & ORTHOPEDIC SHOES INC
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 9909 CANOGA AVE UNIT I
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City | CHATSWORTH
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State | CA
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Zip | 91311-3070
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Country | US
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Telephone | 818-701-5101
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Fax | 877-320-4743
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Provider Business Mailing Address
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Address Line | 9909 CANOGA AVE UNIT I
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City | CHATSWORTH
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State | CA
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Zip | 91311-3070
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Country | US
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Telephone | 818-701-5101
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Fax | 877-320-4743
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MIN YOO
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Credential |
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Telephone | 818-701-5101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 49653
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License Number State | CA
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