Provider Demographics
NPI:1346230315
Name:EAGLE MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:EAGLE MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SANG
Authorized Official - Middle Name:JIN
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-559-6390
Mailing Address - Street 1:613 S VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2424
Mailing Address - Country:US
Mailing Address - Phone:818-559-6390
Mailing Address - Fax:818-559-2355
Practice Address - Street 1:613 S VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2424
Practice Address - Country:US
Practice Address - Phone:818-559-6390
Practice Address - Fax:818-559-2355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02181FMedicaid
CADME02181FMedicaid