Healthcare Provider Details

I. General information

NPI: 1699841700
Provider Name (Legal Business Name): EJIKE ONYEADOR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 ATLANTIC AVE SUITE 715
LONG BEACH CA
90813-3408
US

IV. Provider business mailing address

1045 ATLANTIC AVE SUITE 715
LONG BEACH CA
90813-3408
US

V. Phone/Fax

Practice location:
  • Phone: 562-983-5496
  • Fax: 562-432-1864
Mailing address:
  • Phone: 562-983-5496
  • Fax: 562-432-1864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA45589
License Number StateCA

VIII. Authorized Official

Name: MR. EJIKE CELESTINE ONYEADOR
Title or Position: PHYSICIAN OWNER
Credential:
Phone: 562-983-5496