Healthcare Provider Details

I. General information

NPI: 1801323696
Provider Name (Legal Business Name): NDIDI ONUGHA UKA DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 E CARSON ST SUITE N
CARSON CA
90745-2767
US

IV. Provider business mailing address

732 255TH ST UNIT E
HARBOR CITY CA
90710-3149
US

V. Phone/Fax

Practice location:
  • Phone: 310-835-3969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60123
License Number StateCA

VIII. Authorized Official

Name: NDIDI UKA
Title or Position: OWNER
Credential:
Phone: 310-926-3570