=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225209372
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANIEL CHUKWU
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2008
-----------------------------------------------------
Last Update Date | 09/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14023 CRENSHAW BLVD SUITE 4
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90250-9255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-675-4666
-----------------------------------------------------
Fax | 310-675-4004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14023 CRENSHAW BLVD SUITE 4
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90250-9255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-675-4666
-----------------------------------------------------
Fax | 310-675-4004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DANIEL CHUKWU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-675-4666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 102873
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------