MEDICARE: L A 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	1127780001	CA

General Provider Information

NPI Number	:	1427031103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L A MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	966 S WESTERN AVE
Second Line	:	104
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-1013
Country	:	US
Telephone Number	:	323-734-4800
Fax Number	:	373-734-0941

Provider Business Practice Location Address
First Line	:	966 S WESTERN AVE
Second Line	:	104
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-1013
Country	:	US
Telephone Number	:	323-734-4800
Fax Number	:	373-734-0941

Authorized Official
Title or Position	:	CEO
Name	:	CHUN H KIM
Credential	:
Telephone Number	:	323-734-4800

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	10/17/2011

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Directions to “L A MEDICAL SUPPLY INC ” Practice Location

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