Provider Demographics
NPI:1932233343
Name:CHIPATLIN MEDICAL CONCEPT
Entity Type:Organization
Organization Name:CHIPATLIN MEDICAL CONCEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:UZOMA
Authorized Official - Last Name:OSUAGWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-349-8770
Mailing Address - Street 1:11633 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2321
Mailing Address - Country:US
Mailing Address - Phone:310-349-8770
Mailing Address - Fax:310-349-8770
Practice Address - Street 1:11633 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2321
Practice Address - Country:US
Practice Address - Phone:310-349-8770
Practice Address - Fax:310-349-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46254332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46254OtherHMDR LICENSE
CA=========OtherEIN
CA5964470001Medicare NSC