Provider Demographics
NPI:1972882876
Name:KAJA MEDICAL EQUIPMENT AND SUPPLY INC
Entity Type:Organization
Organization Name:KAJA MEDICAL EQUIPMENT AND SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-200-4999
Mailing Address - Street 1:1416 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3228
Mailing Address - Country:US
Mailing Address - Phone:805-641-1905
Mailing Address - Fax:805-641-0359
Practice Address - Street 1:1416 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-3228
Practice Address - Country:US
Practice Address - Phone:805-641-1905
Practice Address - Fax:805-641-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102050738332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies