Healthcare Provider Details

I. General information

NPI: 1023283124
Provider Name (Legal Business Name): EVELYN LILLIAN KACHIKWU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 TRANSMOUNTAIN RD STE B
EL PASO TX
79911-3602
US

IV. Provider business mailing address

1325 N ROSE DR STE 210
PLACENTIA CA
92870-3840
US

V. Phone/Fax

Practice location:
  • Phone: 915-215-8400
  • Fax: 915-612-9253
Mailing address:
  • Phone: 714-961-5804
  • Fax: 714-961-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberV8657
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA94067
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA94067
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberV8657
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: