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General NPI Number Information
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NPI Number | 1598163339
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Entity Type | Organization
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Legal Business Name | NWOGENE MANAGEMENT CORPORATION
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Dates
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Enumeration Date | 12/10/2014
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Last Update Date | 12/10/2014
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Provider Practice Location Address
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Address Line | 8615 CRENSHAW BLVD SUITE 203
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City | INGLEWOOD
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State | CA
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Zip | 90305-2349
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Country | US
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Telephone | 424-331-5716
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Fax | 424-331-5717
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Provider Business Mailing Address
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Address Line | 8615 CRENSHAW BLVD SUITE 203
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City | INGLEWOOD
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State | CA
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Zip | 90305-2349
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Country | US
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Telephone | 424-331-5716
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Fax | 424-331-5717
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. GODFREY NWOGENE
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Credential |
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Telephone | 310-256-5936
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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 |
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License Number State |
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