Healthcare Provider Details

I. General information

NPI: 1508392457
Provider Name (Legal Business Name): UZOAMAKA KIMBERLY EZENDU DIKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 SANTA MONICA BLVD STE 200
SANTA MONICA CA
90404-1955
US

IV. Provider business mailing address

6431 FANNIN ST SUITE MSB 1.134
HOUSTON TX
77030-1501
US

V. Phone/Fax

Practice location:
  • Phone: 310-453-1871
  • Fax:
Mailing address:
  • Phone: 713-500-6500
  • Fax: 713-500-6497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA196333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: