Provider Demographics
NPI:1720062482
Name:KAZZ MEDICAL SUPPLY SERVICES
Entity Type:Organization
Organization Name:KAZZ MEDICAL SUPPLY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOF OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ABIODUN
Authorized Official - Middle Name:L
Authorized Official - Last Name:AKANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-461-0020
Mailing Address - Street 1:1680 VINE ST
Mailing Address - Street 2:SUITE 1018
Mailing Address - City:HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90028-8804
Mailing Address - Country:US
Mailing Address - Phone:323-461-0020
Mailing Address - Fax:323-461-0244
Practice Address - Street 1:1680 VINE ST
Practice Address - Street 2:SUITE 1018
Practice Address - City:HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90028-8804
Practice Address - Country:US
Practice Address - Phone:323-461-0020
Practice Address - Fax:323-461-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5293360001Medicare ID - Type Unspecified