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General NPI Number Information
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NPI Number | 1124492087
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Entity Type | Individual
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Provider Name | CHINEDU JOHN EZEJI-OKOYE DDS
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Gender | Male
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Dates
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Enumeration Date | 11/16/2015
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Last Update Date | 11/16/2015
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Provider Practice Location Address
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Address Line | 1526 5TH AVE
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City | SAN RAFAEL
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State | CA
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Zip | 94901-1852
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Country | US
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Telephone | 415-453-6409
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Fax |
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Provider Business Mailing Address
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Address Line | 1519 HIGH PARK DRIVE NW
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City | HIGH RIVER
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State | AB
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Zip | T1V0A4
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Country | CA
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Telephone | 403-701-6272
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 44586
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License Number State | CA
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