Healthcare Provider Details

I. General information

NPI: 1295262558
Provider Name (Legal Business Name): IKECHUKWU KINGSLEY AMOBI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MOUNT VERNON AVE
BAKERSFIELD CA
93306-4018
US

IV. Provider business mailing address

714 E SKYLARK ST
ONTARIO CA
91761-5856
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-2000
  • Fax:
Mailing address:
  • Phone: 909-240-9831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number67030
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: