MEDICARE: HONG SHONG ENTERPRISES, 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	50652	CA
2	3336C0004X	Compounding Pharmacy	50652	CA
3	3336C0003X	Community/Retail Pharmacy	50652	CA

General Provider Information

NPI Number	:	1518253863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HONG SHONG ENTERPRISES, INC

Provider Business Mailing Address
First Line	:	865 PATRIOT DR
Second Line	:	SUITE 103
City	:	MOORPARK
State	:	CA
Zip	:	93021-3407
Country	:	US
Telephone Number	:	805-523-8300
Fax Number	:	805-523-8333

Provider Business Practice Location Address
First Line	:	865 PATRIOT DR
Second Line	:	SUITE 103
City	:	MOORPARK
State	:	CA
Zip	:	93021-3407
Country	:	US
Telephone Number	:	805-523-8300
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	PETER WANG
Credential	:
Telephone Number	:	805-990-8555

Provider Enumeration Date	:	06/24/2011
Last Update Date	:	10/02/2011

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Directions to “HONG SHONG ENTERPRISES, INC ” Practice Location

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