Provider Demographics
NPI:1255735171
Name:MED NATION, INC.
Entity type:Organization
Organization Name:MED NATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:N
Authorized Official - Last Name:OPOKU
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:818-776-1171
Mailing Address - Street 1:7012 RESEDA BLVD.
Mailing Address - Street 2:SUITE F
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335
Mailing Address - Country:US
Mailing Address - Phone:818-776-1171
Mailing Address - Fax:818-304-7425
Practice Address - Street 1:7012 RESEDA BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335
Practice Address - Country:US
Practice Address - Phone:818-776-1171
Practice Address - Fax:818-776-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11418208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty