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General NPI Number Information
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NPI Number | 1841441896
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Entity Type | Organization
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Legal Business Name | CHUKWUMA J. UDEH, MD INC.
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Dates
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Enumeration Date | 10/08/2008
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Last Update Date | 05/08/2009
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Provider Practice Location Address
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Address Line | 399 E HIGHLAND AVE STE 415
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-3815
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Country | US
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Telephone | 909-882-7554
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Fax | 909-882-6511
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Provider Business Mailing Address
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Address Line | 399 E HIGHLAND AVE STE 415
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-3815
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Country | US
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Telephone | 909-882-7554
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Fax | 909-882-6511
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Authorized Official
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Title or Position | CORPORATION PRESIDENT
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Name | DR. CHUKWUMA JOHN UDEH
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Credential | MD
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Telephone | 909-882-7554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0005X
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Taxonomy Name | Ambulatory Family Planning Facility
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License Number | 00G460741
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QA0005X
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Taxonomy Name | Ambulatory Family Planning Facility
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License Number | 00G460740
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License Number State | CA
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