MEDICARE: TED TRADING COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	103546	CA

General Provider Information

NPI Number	:	1023042090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TED TRADING COMPANY

Provider Business Mailing Address
First Line	:	1614 ANAHEIM ST
Second Line	:
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-3214
Country	:	US
Telephone Number	:	310-517-9390
Fax Number	:	310-517-9390

Provider Business Practice Location Address
First Line	:	1614 ANAHEIM ST
Second Line	:
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-3214
Country	:	US
Telephone Number	:	310-517-9390
Fax Number	:	310-517-9390

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. TIMOTHY CHIDOZIE EKWEGH
Credential	:
Telephone Number	:	310-517-9390

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	12/29/2008

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