Organization
KIMBO MEDICAL DISTRIBUTOR
Active
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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