MEDICARE: KELECHI HERBERT UMOGA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	A209659	CA

General Provider Information

NPI Number	:	1205579810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELECHI HERBERT UMOGA

Provider Business Mailing Address
First Line	:	1501 TROUSDALE DR
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-4506
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 TROUSDALE DR
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-4506
Country	:	US
Telephone Number	:	650-696-5170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2022
Last Update Date	:	06/01/2026

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Directions to “ KELECHI HERBERT UMOGA ” Practice Location

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