Healthcare Provider Details

I. General information

NPI: 1033136544
Provider Name (Legal Business Name): CHARLES IKECHUKWU OKOYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 05/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 S MAIN ST
LOS ANGELES CA
90037-2731
US

IV. Provider business mailing address

4405 S MAIN ST
LOS ANGELES CA
90037-2731
US

V. Phone/Fax

Practice location:
  • Phone: 323-231-0659
  • Fax:
Mailing address:
  • Phone: 323-231-0659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA96076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: