Provider Demographics
NPI:1023299021
Name:VITAL REMEDIES, INC.
Entity type:Organization
Organization Name:VITAL REMEDIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SU
Authorized Official - Middle Name:YEONG
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-562-9605
Mailing Address - Street 1:522 S VERDUGO DR
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2344
Mailing Address - Country:US
Mailing Address - Phone:818-562-9605
Mailing Address - Fax:818-562-9606
Practice Address - Street 1:522 S VERDUGO DR
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2344
Practice Address - Country:US
Practice Address - Phone:818-562-9605
Practice Address - Fax:818-562-9606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-18
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6061680001Medicare NSC