Provider Demographics
NPI:1053805341
Name:BACANI, JIM
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:BACANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5830 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2628
Mailing Address - Country:US
Mailing Address - Phone:626-807-0401
Mailing Address - Fax:
Practice Address - Street 1:10865 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-3053
Practice Address - Country:US
Practice Address - Phone:626-807-0401
Practice Address - Fax:714-333-4980
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No251G00000XAgenciesHospice Care, Community Based
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies