Provider Demographics
NPI:1447431168
Name:FIVE STAR MEDICAL SUPPL INC.
Entity Type:Organization
Organization Name:FIVE STAR MEDICAL SUPPL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOVSEPYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-764-0278
Mailing Address - Street 1:7457 LAUREL CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-3135
Mailing Address - Country:US
Mailing Address - Phone:818-764-0278
Mailing Address - Fax:
Practice Address - Street 1:7457 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-3135
Practice Address - Country:US
Practice Address - Phone:818-764-0278
Practice Address - Fax:818-764-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6047970001Medicare NSC