Provider Demographics
NPI:1972671683
Name:WELCOME MEDICAL SUPPLIES, INC
Entity Type:Organization
Organization Name:WELCOME MEDICAL SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-530-5664
Mailing Address - Street 1:9240 GARDEN GROVE BLVD STE 13
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1400
Mailing Address - Country:US
Mailing Address - Phone:714-530-5664
Mailing Address - Fax:714-530-0860
Practice Address - Street 1:9240 GARDEN GROVE BLVD STE 13
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1400
Practice Address - Country:US
Practice Address - Phone:714-530-5664
Practice Address - Fax:714-530-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101398332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02984FMedicaid
CADME02984FMedicaid