MEDICARE: NDIKA FOMUKONG P.A.C

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	363LP2300X	Primary Care Nurse Practitioner	NP 17180	CA
2	363A00000X	Physician Assistant	PA17839	CA

General Provider Information

NPI Number	:	1497700066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NDIKA FOMUKONG P.A.C

Provider Business Mailing Address
First Line	:	6470 VAN NUYS BLVD STE D
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-1499
Country	:	US
Telephone Number	:	323-733-7242
Fax Number	:	310-975-1292

Provider Business Practice Location Address
First Line	:	6470 VAN NUYS BLVD STE D
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-1499
Country	:	US
Telephone Number	:	323-733-7242
Fax Number	:	310-975-1292

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	04/10/2026

Similar Medicare Providers

1598427288 — HEAVENLY HEALTHCARE SERVICES, INC
Practice Location Address:

6470 VAN NUYS BLVD STE E
VAN NUYS, CA
91401-1499

Practice Phone: 818-671-1757
Practice Fax: 818-671-1405

1295682656 — NARINE KHRAYAN
Practice Location Address:

5708 BUFFALO AVE
VAN NUYS, CA
91401-4507

Practice Phone: 818-371-7334
Practice Fax:

1144468992 — MILLENNIUM HOME HEALTH CARE INC.
Practice Location Address:

13758 VICTORY BLVD , SUITE 208
VAN NUYS, CA
91401-2319

Practice Phone: 818-317-1313
Practice Fax:

1629071410 — DR. DON P WRIGHT D.C.
Practice Location Address:

13746 VICTORY BLVD , 201
VAN NUYS, CA
91401-6716

Practice Phone: 818-988-3341
Practice Fax: 818-988-3343

1720088800 — PRESCRIPTIONS PLUS
Practice Location Address:

6312 VAN NUYS BLVD
VAN NUYS, CA
91401-2610

Practice Phone: 818-785-0441
Practice Fax: 818-785-1315

1184625568 — NORTHEAST VALLEY HEALTH CORPORATION
Practice Location Address:

6551 VAN NUYS BLVD FL 2
VAN NUYS, CA
91401-1566

Practice Phone: 818-765-8656
Practice Fax: 818-765-6982

Directions to “ NDIKA FOMUKONG P.A.C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.