MEDICARE: CHIDIMMAH ONYINYE AGBASI LVN

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	164X00000X	Licensed Vocational Nurse	754376	CA

General Provider Information

NPI Number	:	1417815135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIDIMMAH ONYINYE AGBASI LVN

Provider Business Mailing Address
First Line	:	2121 W 96TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-3731
Country	:	US
Telephone Number	:	424-603-9302
Fax Number	:

Provider Business Practice Location Address
First Line	:	5701 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90062-2714
Country	:	US
Telephone Number	:	424-603-9302
Fax Number	:

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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