Healthcare Provider Details

I. General information

NPI: 1669115341
Provider Name (Legal Business Name): CHINENYE UMA UZOH KALU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DEKALB AVE
BROOKLYN NY
11201-5493
US

IV. Provider business mailing address

121 DEKALB AVE
BROOKLYN NY
11201-5493
US

V. Phone/Fax

Practice location:
  • Phone: 718-250-8000
  • Fax:
Mailing address:
  • Phone: 718-250-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number340694
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: