Provider Demographics
NPI:1134968100
Name:GRANDCARE MEDICAL LLC
Entity type:Organization
Organization Name:GRANDCARE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ZHUOXIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-502-1736
Mailing Address - Street 1:1515 W CAMERON AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2734
Mailing Address - Country:US
Mailing Address - Phone:626-502-1736
Mailing Address - Fax:626-502-1746
Practice Address - Street 1:1515 W CAMERON AVE STE 202
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2734
Practice Address - Country:US
Practice Address - Phone:626-502-1736
Practice Address - Fax:626-502-1746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies