Healthcare Provider Details

I. General information

NPI: 1366493595
Provider Name (Legal Business Name): STEPHEN CHUKWUMA EZEJI-OKOYE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE
PALO ALTO CA
94304-1207
US

IV. Provider business mailing address

180 BELLA VISTA LN
WATSONVILLE CA
95076-8693
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax: 650-852-3228
Mailing address:
  • Phone: 831-763-3862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA049687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: