MEDICARE: KSS HOLDINGS, 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	:	1508151051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KSS HOLDINGS, INC.

Provider Business Mailing Address
First Line	:	14635 TITUS ST
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-4922
Country	:	US
Telephone Number	:	818-782-2030
Fax Number	:	818-782-2299

Provider Business Practice Location Address
First Line	:	14635 TITUS ST
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-4922
Country	:	US
Telephone Number	:	818-782-2030
Fax Number	:	818-782-2299

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PETROS HAJIAN
Credential	:
Telephone Number	:	818-782-2030

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	06/13/2011

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Directions to “KSS HOLDINGS, INC. ” Practice Location

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