Provider Demographics
NPI:1265670350
Name:S J MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:S J MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTOUR
Authorized Official - Middle Name:
Authorized Official - Last Name:KAGRAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-998-2925
Mailing Address - Street 1:840 WILLOW ST UNIT A300
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-2381
Mailing Address - Country:US
Mailing Address - Phone:408-998-2925
Mailing Address - Fax:408-998-2931
Practice Address - Street 1:840 WILLOW STREET
Practice Address - Street 2:UNIT A300
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125
Practice Address - Country:US
Practice Address - Phone:408-998-2925
Practice Address - Fax:408-998-2931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6332920001Medicare NSC