Healthcare Provider Details

I. General information

NPI: 1437386182
Provider Name (Legal Business Name): MR. JUDE KANAYO NJOKU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 W IMPERIAL HWY SUITE 200M
INGLEWOOD CA
90303
US

IV. Provider business mailing address

13219 RUTHELEN ST
GARDENA CA
90249-1823
US

V. Phone/Fax

Practice location:
  • Phone: 323-754-2989
  • Fax: 323-754-2989
Mailing address:
  • Phone: 323-754-2989
  • Fax: 323-754-7355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0324083963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: