Provider Demographics
NPI:1073294039
Name:KIDMED LLC
Entity Type:Organization
Organization Name:KIDMED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUIZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-589-1911
Mailing Address - Street 1:6425 VALLEY CROSSING WAY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-2273
Mailing Address - Country:US
Mailing Address - Phone:404-551-9826
Mailing Address - Fax:770-589-1910
Practice Address - Street 1:1715 FRIENDSHIP CIR STE 400
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-6921
Practice Address - Country:US
Practice Address - Phone:404-551-9826
Practice Address - Fax:770-589-1910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies