Healthcare Provider Details

I. General information

NPI: 1114417854
Provider Name (Legal Business Name): OLUKEMI A KUKU DNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLUKEMI A KUKU-OJO

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 PORT CHICAGO HWY
CONCORD CA
94520-1121
US

IV. Provider business mailing address

PO BOX 1776
VACAVILLE CA
95696-1776
US

V. Phone/Fax

Practice location:
  • Phone: 925-674-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95009037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: