MEDICARE: THEODORE IPOTE YOHAN

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		CA

General Provider Information

NPI Number	:	1124031356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE IPOTE YOHAN

Provider Business Mailing Address
First Line	:	920 E GARVEY AVE
Second Line	:
City	:	MONTEREY PARK
State	:	CA
Zip	:	91755-3044
Country	:	US
Telephone Number	:	626-280-4504
Fax Number	:	626-280-8272

Provider Business Practice Location Address
First Line	:	920 E GARVEY AVE
Second Line	:
City	:	MONTEREY PARK
State	:	CA
Zip	:	91755-3044
Country	:	US
Telephone Number	:	626-280-4504
Fax Number	:	626-280-8272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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