MEDICARE: EXSPRESS 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	103342	CA

General Provider Information

NPI Number	:	1609065879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXSPRESS MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	4221 WILSHIRE BLVD
Second Line	:	SUITE 29019
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3512
Country	:	US
Telephone Number	:	323-933-5997
Fax Number	:	323-933-6435

Provider Business Practice Location Address
First Line	:	4221 WILSHIRE BLVD
Second Line	:	SUITE 29019
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3512
Country	:	US
Telephone Number	:	323-933-5997
Fax Number	:	323-933-6435

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SYLVESTER ISONG
Credential	:
Telephone Number	:	323-933-5997

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	10/23/2007

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