Provider Demographics
NPI:1417151853
Name:ULTIMUM-CARE MEDICAL DISTRIBUTORS
Entity Type:Organization
Organization Name:ULTIMUM-CARE MEDICAL DISTRIBUTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ASUKWO
Authorized Official - Middle Name:ARUK
Authorized Official - Last Name:NTUEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-789-7391
Mailing Address - Street 1:7403 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-4931
Mailing Address - Country:US
Mailing Address - Phone:323-789-7391
Mailing Address - Fax:323-789-7394
Practice Address - Street 1:7403 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-4931
Practice Address - Country:US
Practice Address - Phone:323-789-7391
Practice Address - Fax:323-789-7394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1156510001Medicare NSC