Healthcare Provider Details

I. General information

NPI: 1275437915
Provider Name (Legal Business Name): UKEME A UDOH NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 CRAPE MYRTLE CIR
CHINO HILLS CA
91709-4236
US

IV. Provider business mailing address

3015 CRAPE MYRTLE CIR
CHINO HILLS CA
91709-4236
US

V. Phone/Fax

Practice location:
  • Phone: 202-702-0323
  • Fax:
Mailing address:
  • Phone: 202-702-0323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10066633
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: