Healthcare Provider Details

I. General information

NPI: 1417650425
Provider Name (Legal Business Name): LINDA KOSISOCHUKWU CHUDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA KOSISOCHUKWU EPUNDU

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 N RIVERSIDE AVE
RIALTO CA
92376-8069
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 901-874-2371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT-4894
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA207475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: