Provider Demographics
NPI:1801828900
Name:A1 MEDICAL EQUIPMENT & SUPPLY, INC
Entity Type:Organization
Organization Name:A1 MEDICAL EQUIPMENT & SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:YONATAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YIHDEGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-649-2641
Mailing Address - Street 1:314 E HILLCREST BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-2423
Mailing Address - Country:US
Mailing Address - Phone:310-649-2641
Mailing Address - Fax:310-649-5073
Practice Address - Street 1:314 E HILLCREST BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-2423
Practice Address - Country:US
Practice Address - Phone:310-649-2641
Practice Address - Fax:310-649-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45648332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801828900Medicaid
CA5737600001Medicare NSC