Provider Demographics
NPI:1851751564
Name:TKO MEDICAL CORPORATION
Entity Type:Organization
Organization Name:TKO MEDICAL CORPORATION
Other - Org Name:TKO MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-681-4119
Mailing Address - Street 1:2305 E ASHLAN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-3102
Mailing Address - Country:US
Mailing Address - Phone:855-707-9787
Mailing Address - Fax:888-377-5190
Practice Address - Street 1:2305 E ASHLAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-3102
Practice Address - Country:US
Practice Address - Phone:855-707-9787
Practice Address - Fax:888-377-5190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77966332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106636OtherHMDR
CA77966OtherHMDR
CA1851751564Medicaid