Provider Demographics
NPI:1366554263
Name:MEDICAL BASE CORP
Entity type:Organization
Organization Name:MEDICAL BASE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-582-1670
Mailing Address - Street 1:9519 E. RUSH ST. UNIT B
Mailing Address - Street 2:
Mailing Address - City:SO. EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733
Mailing Address - Country:US
Mailing Address - Phone:626-582-1670
Mailing Address - Fax:626-582-1679
Practice Address - Street 1:9519 RUSH ST STE B
Practice Address - Street 2:
Practice Address - City:SOUTH EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-1556
Practice Address - Country:US
Practice Address - Phone:626-582-1670
Practice Address - Fax:626-582-1679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies