Kimbo Medical Distributor

Primary specialty

Parenteral & Enteral Nutrition Supplies (DME)Taxonomy code 332BP3500X

License

44548 Issued in CA

Legal business name

KIMBO MEDICAL DISTRIBUTOR

Practice address

407 N Avalon Blvd
Wilmington, CA 90744-5803

Phone

(310) 834-9574

Fax

(866) 398-5898

NPI assigned

May 1, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Godwill Tabe Tamunang, P.T

Title

C.E.O

Phone

(310) 834-9574

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• KIMBO MEDICAL DISTRIBUTOR Doing business as

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320796800000",
    "number": "1891916367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 N AVALON BLVD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907445803",
            "telephone_number": "310-834-9574",
            "fax_number": "866-398-5898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 N AVALON BLVD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907445803",
            "telephone_number": "310-834-9574",
            "fax_number": "866-398-5898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBO MEDICAL DISTRIBUTOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2011-11-09",
        "status": "A",
        "authorized_official_last_name": "TAMUNANG",
        "authorized_official_first_name": "GODWILL",
        "authorized_official_middle_name": "TABE",
        "authorized_official_title_or_position": "C.E.O",
        "authorized_official_telephone_number": "310-834-9574",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "44548",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "CA",
            "license": "44548",
            "primary": true
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "CA",
            "license": "44548",
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "CA",
            "license": "44548",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMCSUBT9E",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KIMBO MEDICAL DISTRIBUTOR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Payam John Kahen, M.D.
• Selene Ketchum, CLEC CBD
• Tariq Tahir Khraishi, O.D.
• Andrew Kim, D.D.S.
• Kimbo Drug & Alcohol Rehabilitation Services
• Marilyn Kleist, LMFT
• Krynen Chiropractic Inc
• Paul J Krynen, D.C.
• Antoinette Laura, NP
• Benjamin Bao Le, DMD

• Parenteral & Enteral Nutrition Supplies (DME) in Wilmington, CA
• Providers in Wilmington, CA by specialty
• Parenteral & Enteral Nutrition Supplies (DME) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2011; 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.