Provider Demographics
NPI:1053590364
Name:OAK MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:OAK MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIGRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OGANESIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-447-9014
Mailing Address - Street 1:140 EAST SANTA CLARA AVENUE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006
Mailing Address - Country:US
Mailing Address - Phone:626-447-9014
Mailing Address - Fax:626-447-9062
Practice Address - Street 1:140 E SANTA CLARA ST
Practice Address - Street 2:SUITE 13
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3234
Practice Address - Country:US
Practice Address - Phone:626-447-9014
Practice Address - Fax:626-447-9062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48021332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6036370001Medicare NSC