Provider Demographics
NPI:1679681340
Name:A C T MEDICAL SUPPLIES, INC
Entity Type:Organization
Organization Name:A C T MEDICAL SUPPLIES, INC
Other - Org Name:ACT MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:KHATOL
Authorized Official - Middle Name:M
Authorized Official - Last Name:HASSANZADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-430-6140
Mailing Address - Street 1:2928 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5305
Mailing Address - Country:US
Mailing Address - Phone:562-430-6140
Mailing Address - Fax:562-430-6143
Practice Address - Street 1:2928 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5305
Practice Address - Country:US
Practice Address - Phone:562-430-6140
Practice Address - Fax:562-430-6143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03304FMedicaid
CA5317990001Medicare ID - Type Unspecified
CA5317990001Medicare NSC