Crossroad International, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

CROSSROAD INTERNATIONAL, INC.

Doing business as

Healthy Life Medical Supply

Practice address

6771 Beach Blvd
Buena Park, CA 90621-3470

Phone

(714) 883-1098

NPI assigned

Mar 25, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Hyung Mo Kim

Title

Owner

Phone

(714) 883-1098

Specialties & licenses 1

Addresses

Other names 1

• Healthy Life Medical Supply Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648166400000",
    "number": "1063162840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6771 BEACH BLVD",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906213470",
            "telephone_number": "714-883-1098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6771 BEACH BLVD",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906213470",
            "telephone_number": "714-883-1098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROAD INTERNATIONAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-25",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "HYUNG",
        "authorized_official_middle_name": "MO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-883-1098"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healthy Life Medical Supply",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Buena Park, CA
• Providers in Buena Park, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.