Provider Demographics
NPI:1043243462
Name:VALLEY MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:VALLEY MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JADE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-997-0069
Mailing Address - Street 1:7130 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3005
Mailing Address - Country:US
Mailing Address - Phone:818-997-0069
Mailing Address - Fax:818-997-8258
Practice Address - Street 1:7130 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3005
Practice Address - Country:US
Practice Address - Phone:818-997-0069
Practice Address - Fax:818-997-8258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103029332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03179FMedicaid
CA4839490001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER