Healthcare Provider Details

I. General information

NPI: 1245121037
Provider Name (Legal Business Name): PIKEMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12612 INGLEWOOD AVE APT 4
HAWTHORNE CA
90250-4272
US

IV. Provider business mailing address

12612 INGLEWOOD AVE APT 4
HAWTHORNE CA
90250-4272
US

V. Phone/Fax

Practice location:
  • Phone: 424-309-4480
  • Fax:
Mailing address:
  • Phone: 424-309-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: IKE PAUL OKONJI
Title or Position: OP
Credential:
Phone: 424-309-4480