Healthcare Provider Details

I. General information

NPI: 1699409474
Provider Name (Legal Business Name): CHIDUM EKPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date: 09/11/2025
Reactivation Date: 10/01/2025

III. Provider practice location address

39115 TRADE CENTER DR STE 203
PALMDALE CA
93551-3649
US

IV. Provider business mailing address

39115 TRADE CENTER DR STE 203
PALMDALE CA
93551-3649
US

V. Phone/Fax

Practice location:
  • Phone: 661-223-3880
  • Fax:
Mailing address:
  • Phone: 661-223-3880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: