Provider Demographics
NPI:1861509259
Name:MAPLE MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:MAPLE MEDICAL SUPPLY INC
Other - Org Name:MAPLE MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:SUNGLIN
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-469-3686
Mailing Address - Street 1:228 N L ST
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-2106
Mailing Address - Country:US
Mailing Address - Phone:559-591-6008
Mailing Address - Fax:
Practice Address - Street 1:228 N L ST
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-2106
Practice Address - Country:US
Practice Address - Phone:559-591-6008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103613332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03225FMedicaid
CAZZZ66519ZOtherBLUE SHEILD
CA5326260001Medicare ID - Type Unspecified