MEDICARE: HEALTHY FEET DIABETIC SHOES, 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

General Provider Information

NPI Number	:	1427272954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY FEET DIABETIC SHOES, INC.

Provider Business Mailing Address
First Line	:	5637 CAHUENGA BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-2104
Country	:	US
Telephone Number	:	818-755-4444
Fax Number	:

Provider Business Practice Location Address
First Line	:	5637 CAHUENGA BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-2104
Country	:	US
Telephone Number	:	818-755-4444
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ZHORZH GEORGE NADIMYAN
Credential	:
Telephone Number	:	818-755-4444

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	04/24/2008

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