MEDICARE: DR. UZOAMAKA KIMBERLY EZENDU DIKE M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207RG0100X	Gastroenterology Physician	A196333	CA

General Provider Information

NPI Number	:	1508392457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. UZOAMAKA KIMBERLY EZENDU DIKE M.D.

Provider Business Mailing Address
First Line	:	6431 FANNIN ST
Second Line	:	SUITE MSB 1.134
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:	713-500-6500
Fax Number	:	713-500-6497

Provider Business Practice Location Address
First Line	:	1919 SANTA MONICA BLVD STE 200
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-1955
Country	:	US
Telephone Number	:	310-453-1871
Fax Number	:

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	09/06/2024

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