Provider Demographics
NPI:1548379514
Name:AKANIFIOK CLEMENT INYANG FRIENDLY MEDICAL SUPPLY
Entity Type:Organization
Organization Name:AKANIFIOK CLEMENT INYANG FRIENDLY MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AKANIFIOK
Authorized Official - Middle Name:CLEMENT
Authorized Official - Last Name:INYANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-799-0868
Mailing Address - Street 1:2130 HUNTINGTON DR STE 313
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4980
Mailing Address - Country:US
Mailing Address - Phone:626-799-0868
Mailing Address - Fax:626-799-8848
Practice Address - Street 1:2130 HUNTINGTON DR STE 313
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4980
Practice Address - Country:US
Practice Address - Phone:626-799-0868
Practice Address - Fax:626-799-8848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101806332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03059FMedicaid
CA1290850001Medicare ID - Type Unspecified