MEDICARE: KAL MEDICAL SUPPLIES 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	6814204-1714	UT
2	332B00000X	Durable Medical Equipment & Medical Supplies		UT

General Provider Information

NPI Number	:	1386827418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAL MEDICAL SUPPLIES INC.

Provider Business Mailing Address
First Line	:	621 W 3900 S STE A100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84123-1347
Country	:	US
Telephone Number	:	877-266-9545
Fax Number	:	801-293-9150

Provider Business Practice Location Address
First Line	:	621 W 3900 S STE A100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84123-1347
Country	:	US
Telephone Number	:	877-266-9545
Fax Number	:	801-293-9150

Authorized Official
Title or Position	:	DIRECTOR
Name	:	VINCENT KALESI NWIBIABU
Credential	:
Telephone Number	:	877-266-9545

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	10/26/2021

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