Healthcare Provider Details

I. General information

NPI: 1861734006
Provider Name (Legal Business Name): JOY EKWUEME M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 S SEPULVEDA BLVD STE 120
LOS ANGELES CA
90045-3807
US

IV. Provider business mailing address

8540 S SEPULVEDA BLVD STE 120
LOS ANGELES CA
90045-3807
US

V. Phone/Fax

Practice location:
  • Phone: 310-363-0322
  • Fax: 309-326-4624
Mailing address:
  • Phone: 310-363-0322
  • Fax: 309-326-4624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA150868
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberA150868
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA150868
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: