Provider Demographics
NPI:1932135258
Name:CANAAN MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:CANAAN MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOK HEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-935-4000
Mailing Address - Street 1:903 S CRENSHAW BLVD
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1964
Mailing Address - Country:US
Mailing Address - Phone:323-935-4000
Mailing Address - Fax:323-937-8970
Practice Address - Street 1:903 S CRENSHAW BLVD
Practice Address - Street 2:SUITE 102A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1964
Practice Address - Country:US
Practice Address - Phone:323-935-4000
Practice Address - Fax:323-937-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6057490002332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6057490002Medicare NSC