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General NPI Number Information
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NPI Number | 1215115704
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Entity Type | Organization
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Legal Business Name | CHARLES I OKONKWO MD INC
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 04/19/2011
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Provider Practice Location Address
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Address Line | 231 W VERNON AVE SUITE 105
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City | LOS ANGELES
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State | CA
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Zip | 90037-2700
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Country | US
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Telephone | 323-234-7200
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Fax | 323-234-1922
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Provider Business Mailing Address
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Address Line | 231 W VERNON AVE SUITE 105
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City | LOS ANGELES
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State | CA
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Zip | 90037-2700
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Country | US
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Telephone | 323-234-7200
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES IFEANYI OKONKWO
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Credential | M.D.
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Telephone | 323-234-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A31084
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License Number State | CA
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