Provider Demographics
NPI:1053187369
Name:KMEDICALSUPPLY1.COM
Entity type:Organization
Organization Name:KMEDICALSUPPLY1.COM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMLOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-209-3888
Mailing Address - Street 1:2146 SWORD DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-6028
Mailing Address - Country:US
Mailing Address - Phone:972-209-3888
Mailing Address - Fax:972-767-0148
Practice Address - Street 1:2146 SWORD DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-6028
Practice Address - Country:US
Practice Address - Phone:972-209-3888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
No253Z00000XAgenciesIn Home Supportive Care