=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497960819
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OKORONKWO MEDICAL CORP OF ALAMEDA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2007
-----------------------------------------------------
Last Update Date | 12/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10500 MACARTHUR BLVD. SUITE #102
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94605-5248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-569-7326
-----------------------------------------------------
Fax | 510-569-7329
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10500 MACARTHUR BLVD SUITE #102
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94605-5248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-569-7326
-----------------------------------------------------
Fax | 510-569-7329
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR/CEO
-----------------------------------------------------
Name | DR. UCHENNA A OKORONKWO II
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 510-569-7326
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | G55275
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------