Provider Demographics
NPI:1033142310
Name:DYNASTY MEDICAL DISTRIBUTORS INC.
Entity Type:Organization
Organization Name:DYNASTY MEDICAL DISTRIBUTORS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:UBONG
Authorized Official - Middle Name:
Authorized Official - Last Name:EDEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-576-0036
Mailing Address - Street 1:10231 TOPANGA CANYON BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10231 TOPANGA CANYON BLVD STE C
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2804
Practice Address - Country:US
Practice Address - Phone:818-576-0036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43052332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies