Healthcare Provider Details

I. General information

NPI: 1821583584
Provider Name (Legal Business Name): ONYEDIKACHI KENNETH MICHAELS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ONYEDKACHI OGBODO

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 10/12/2026
Certification Date: 10/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COFFEE RD
MODESTO CA
95355-2803
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 209-568-7408
  • Fax: 209-491-7587
Mailing address:
  • Phone: 800-470-0071
  • Fax: 916-854-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA197796
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA197796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: