Provider Demographics
NPI:1568446938
Name:OAKLAND MEDICAL SUPPLY
Entity Type:Organization
Organization Name:OAKLAND MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-268-3228
Mailing Address - Street 1:823 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4422
Mailing Address - Country:US
Mailing Address - Phone:510-268-3228
Mailing Address - Fax:510-268-3238
Practice Address - Street 1:823 HARRISON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4422
Practice Address - Country:US
Practice Address - Phone:510-268-3228
Practice Address - Fax:510-268-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102486332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03067FMedicaid
CADME03067FMedicaid