Healthcare Provider Details

I. General information

NPI: 1750153151
Provider Name (Legal Business Name): KINGJOE CHIGOZIE OKOH NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 10/27/2023
Certification Date: 10/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19017 ENSLOW DR
CARSON CA
90746-2027
US

IV. Provider business mailing address

19017 ENSLOW DR
CARSON CA
90746-2027
US

V. Phone/Fax

Practice location:
  • Phone: 310-381-9054
  • Fax:
Mailing address:
  • Phone: 310-381-9054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number734097
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95007183
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: