Healthcare Provider Details

I. General information

NPI: 1760117535
Provider Name (Legal Business Name): TOCHUKWU ANTHONY MADU MEDICAL DEGREE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR STE 610
ORANGE CA
92868-3857
US

IV. Provider business mailing address

11400 W OLYMPIC BLVD
LOS ANGELES CA
90064-1550
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-1815
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number189780
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number189780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: