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General NPI Number Information
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NPI Number | 1629465273
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Entity Type | Organization
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Legal Business Name | KINGSLEY O. OFOEGBU MD, FACP, INC
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Dates
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Enumeration Date | 04/21/2015
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 644 E REGENT ST STE 200
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City | INGLEWOOD
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State | CA
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Zip | 90301-1444
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Country | US
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Telephone | 310-982-3141
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Fax |
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Provider Business Mailing Address
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Address Line | 20111 WADLEY AVE
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City | CARSON
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State | CA
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Zip | 90746-3046
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Country | US
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Telephone | 310-982-3141
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MR. SEBASTINE E. CHIKEZIE
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Credential | N.P.
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Telephone | 310-982-3141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 688400
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 688400
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 688400
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License Number State | CA
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