Organization
KIMBO MEDICAL DISTRIBUTOR
Active
Other names
KIMBO MEDICAL DISTRIBUTOR
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GODWILL TABE TAMUNANG P.T (C.E.O)
(310) 834-9574
Entity
Organization
Contact information
Practice address
407 N AVALON BLVD, WILMINGTON, CA 90744-5803
(310) 834-9574
(866) 398-5898
Mailing address
407 N AVALON BLVD, WILMINGTON, CA 90744-5803
(310) 834-9574
(866) 398-5898
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
44548
CA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
44548
CA
332BX2000X
Oxygen Equipment & Supplies (DME)
44548
CA
335E00000X
Prosthetic/Orthotic Supplier
44548
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMCSUBT9E
—
CA
Enumeration date
05/01/2007
Last updated
11/09/2011
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