Queen of Angels Medical Supply Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

QUEEN OF ANGELS MEDICAL SUPPLY INC

Practice address

12154 Hamlin St
North Hollywood, CA 91606-1409

Phone

(818) 760-2156

Fax

(818) 942-7059

NPI assigned

Oct 25, 2018

Organization subpart

No

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

Authorized official

Name

Khrist KakosimidiNPI 1487685137

Title

Ceo

Phone

(818) 760-2156

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Khrist Kakosimidi

  • Durable Medical Equipment & Medical Supplies
  • North Hollywood, CA
  • NPI 1487685137
  NPD Authorized official

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

{
    "created_epoch": "1540425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703808000000",
    "number": "1417424797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12154 HAMLIN ST",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916061409",
            "telephone_number": "818-760-2156",
            "fax_number": "818-942-7059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12154 HAMLIN ST",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916061409",
            "telephone_number": "818-760-2156",
            "fax_number": "818-942-7059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEEN OF ANGELS MEDICAL SUPPLY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-25",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A",
        "authorized_official_last_name": "KAKOSIMIDI",
        "authorized_official_first_name": "KHRIST",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-760-2156"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1487685137",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Christian Quijano
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• Durable Medical Equipment & Medical Supplies in North Hollywood, CA
• Providers in North Hollywood, 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 Dec 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.