Healthcare Provider Details

I. General information

NPI: 1679553291
Provider Name (Legal Business Name): IGWE UKOHA M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8920 WILSHIRE BLVD STE 601
BEVERLY HILLS CA
90211-1960
US

IV. Provider business mailing address

8920 WILSHIRE BLVD STE 601
BEVERLY HILLS CA
90211-1960
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-7300
  • Fax: 310-274-7301
Mailing address:
  • Phone: 310-659-9067
  • Fax: 310-659-9057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA51780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: