Provider Demographics
NPI:1629107313
Name:D&S MEDICAL SUPPLIES CO.
Entity Type:Organization
Organization Name:D&S MEDICAL SUPPLIES CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SYVORAVONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-535-0601
Mailing Address - Street 1:1745 W LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3529
Mailing Address - Country:US
Mailing Address - Phone:714-535-0601
Mailing Address - Fax:714-535-6801
Practice Address - Street 1:1745 W LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3529
Practice Address - Country:US
Practice Address - Phone:714-535-0601
Practice Address - Fax:714-535-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46458332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46458OtherHMDR LINCENSE
CA=========OtherEIN