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General NPI Number Information
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NPI Number | 1659755122
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Entity Type | Individual
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Provider Name | ESSIEN UTIBE EKONG M.D
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Gender | Male
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 333 1ST ST STE A
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City | SAN FRANCISCO
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State | CA
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Zip | 94105-2661
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Country | US
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Telephone | 888-803-3370
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Fax |
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Provider Business Mailing Address
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Address Line | 5373 W ALABAMA ST STE 204
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City | HOUSTON
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State | TX
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Zip | 77056-5923
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Country | US
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Telephone | 888-803-3370
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 7571
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | T2157
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License Number State | TX
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