Provider Demographics
NPI:1568465169
Name:KRUIN MEDICAL PRODUCTS, INC.
Entity Type:Organization
Organization Name:KRUIN MEDICAL PRODUCTS, INC.
Other - Org Name:SGV MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RENZ
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:KUIPERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-787-0162
Mailing Address - Street 1:14735 OXNARD ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-3124
Mailing Address - Country:US
Mailing Address - Phone:818-787-0162
Mailing Address - Fax:818-787-0173
Practice Address - Street 1:14735 OXNARD ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-3124
Practice Address - Country:US
Practice Address - Phone:818-787-0162
Practice Address - Fax:818-787-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA013212332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4751760001Medicare ID - Type Unspecified