=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821679630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDCHOICE MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2021
-----------------------------------------------------
Last Update Date | 12/31/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23206 LYONS AVE STE 201
-----------------------------------------------------
City | SANTA CLARITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91321-2672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-282-3664
-----------------------------------------------------
Fax | 818-888-3775
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23206 LYONS AVE STE 201
-----------------------------------------------------
City | SANTA CLARITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91321-2672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-282-3664
-----------------------------------------------------
Fax | 818-888-3775
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/CEO
-----------------------------------------------------
Name | DR. CHIOMA KALU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 818-618-3728
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------