Healthcare Provider Details

I. General information

NPI: 1205388287
Provider Name (Legal Business Name): IFEANYI CHUKWUKA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 03/24/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRANCH HEALTH CLINIC WASHINGTON NAVY YARD BUILDING 175, 915 N ST SE
WASHINGTON DC
20374
US

IV. Provider business mailing address

BRANCH HEALTH CLINIC WASHINGTON NAVY YARD BUILDING 175, 915 N ST SE
WASHINGTON DC
20374
US

V. Phone/Fax

Practice location:
  • Phone: 202-433-2589
  • Fax:
Mailing address:
  • Phone: 757-953-1897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401415430
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: