MEDICARE: VERMONT MEDICAL SUPPLY, INC

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	5735120001	CA

General Provider Information

NPI Number	:	1265477871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERMONT MEDICAL SUPPLY, INC

Provider Business Mailing Address
First Line	:	2681 W OLYMPIC BLVD
Second Line	:	101
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2883
Country	:	US
Telephone Number	:	213-487-5695
Fax Number	:	213-487-0203

Provider Business Practice Location Address
First Line	:	2681 W OLYMPIC BLVD
Second Line	:	101
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2883
Country	:	US
Telephone Number	:	213-487-5695
Fax Number	:	213-487-0203

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BOK HEE CHA
Credential	:
Telephone Number	:	213-487-5695

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	07/08/2009

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