Provider Demographics
NPI:1740365907
Name:EMPORIUM MEDICAL EQUIPMENT INC.
Entity type:Organization
Organization Name:EMPORIUM MEDICAL EQUIPMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YONGIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-224-7474
Mailing Address - Street 1:150 E. IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1019
Mailing Address - Country:US
Mailing Address - Phone:714-224-7474
Mailing Address - Fax:714-525-1162
Practice Address - Street 1:150 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-1019
Practice Address - Country:US
Practice Address - Phone:714-224-7474
Practice Address - Fax:714-525-1162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02903GMedicaid
CA4584380001Medicare NSC