Healthcare Provider Details

I. General information

NPI: 1619821717
Provider Name (Legal Business Name): SUNDAY IFEANYI MADU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11149 CRENSHAW BLVD
INGLEWOOD CA
90303-2338
US

IV. Provider business mailing address

11149 CRENSHAW BLVD
INGLEWOOD CA
90303-2338
US

V. Phone/Fax

Practice location:
  • Phone: 310-808-8494
  • Fax:
Mailing address:
  • Phone: 310-808-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF02260840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: