Provider Demographics
NPI:1558597195
Name:MDK MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:MDK MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-243-1879
Mailing Address - Street 1:925 1/2 BROADWAY AVE.
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205
Mailing Address - Country:US
Mailing Address - Phone:818-243-1879
Mailing Address - Fax:818-243-1892
Practice Address - Street 1:925 1/2 E BROADWAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1203
Practice Address - Country:US
Practice Address - Phone:818-243-1879
Practice Address - Fax:818-243-1892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101-230828332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6367860001Medicare NSC