Provider Demographics
NPI:1922069525
Name:IVEDCO, LLC
Entity Type:Organization
Organization Name:IVEDCO, LLC
Other - Org Name:KABAFUSION TX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MASOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:800-435-3020
Mailing Address - Street 1:17777 CENTER COURT DR N
Mailing Address - Street 2:SUITE 550
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9320
Mailing Address - Country:US
Mailing Address - Phone:800-435-3020
Mailing Address - Fax:562-645-5396
Practice Address - Street 1:3000 KELLWAY DR STE 110
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-3356
Practice Address - Country:US
Practice Address - Phone:800-333-0660
Practice Address - Fax:888-837-2716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 332B00000X, 332BP3500X, 333600000X, 3336C0003X, 3336C0004X, 3336H0001X, 3336S0011X
AROS012983336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100814810 CMedicaid
TX321002Medicaid
OK100814810 AMedicaid
NM13352211Medicaid
TX1218679-05 / 1922069Medicaid