Healthcare Provider Details

I. General information

NPI: 1992202329
Provider Name (Legal Business Name): CHUKWUEMEKA KINGSLEY OKORO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19950 RINALDI ST STE 300
PORTER RANCH CA
91326-4141
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-301-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA165232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: