MEDICARE: CHARLES I OKONKWO MD INC

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	207RC0000X	Cardiovascular Disease Physician	A31084	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W5103B	OTHER	CA	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215115704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES I OKONKWO MD INC

Provider Business Mailing Address
First Line	:	231 W VERNON AVE
Second Line	:	SUITE 105
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2700
Country	:	US
Telephone Number	:	323-234-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 W VERNON AVE
Second Line	:	SUITE 105
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2700
Country	:	US
Telephone Number	:	323-234-7200
Fax Number	:	323-234-1922

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES IFEANYI OKONKWO
Credential	:	M.D.
Telephone Number	:	323-234-7200

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	04/19/2011

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Directions to “CHARLES I OKONKWO MD INC ” Practice Location

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