Kimco Medical Supply Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

5471060001 Issued in CA

Legal business name

KIMCO MEDICAL SUPPLY INC

Practice address

577 N D St
Suite 113
San Bernardino, CA 92401-1324

Phone

(909) 381-1948

Fax

(909) 381-1959

NPI assigned

Jun 26, 2006

Organization subpart

No

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

Authorized official

Name

Miss Dekunle R Shittu

Title

Ceo

Phone

(909) 381-1948

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982631933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "577 N D ST",
            "address_2": "SUITE 113",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924011324",
            "telephone_number": "909-381-1948",
            "fax_number": "909-381-1959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "577 N D ST",
            "address_2": "SUITE 113",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924011324",
            "telephone_number": "909-381-1948",
            "fax_number": "909-381-1959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMCO MEDICAL SUPPLY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHITTU",
        "authorized_official_first_name": "DEKUNLE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "909-381-1948",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "5471060001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sun Ik Kim, MD
• Sunny Eun Kim
• Young Min Kim, M.D.
• Younglee Kim, RN
• Margie Kimble
• Jadyn Alyssa Kimm
• Marilyn H. Kimura, M.D.
• Mona Lee Kindhart, C70772
• Patricia Kiner
• Hailea King-Lenton

• Durable Medical Equipment & Medical Supplies in San Bernardino, CA
• Providers in San Bernardino, 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 Aug 22, 2020; 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.