MEDICARE: MEDCHOICE MEDICAL GROUP

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1821679630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDCHOICE MEDICAL GROUP

Provider Business Mailing Address
First Line	:	23206 LYONS AVE STE 201
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91321-2672
Country	:	US
Telephone Number	:	818-282-3664
Fax Number	:	818-888-3775

Provider Business Practice Location Address
First Line	:	23206 LYONS AVE STE 201
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91321-2672
Country	:	US
Telephone Number	:	818-282-3664
Fax Number	:	818-888-3775

Authorized Official
Title or Position	:	MD/CEO
Name	:	DR. CHIOMA KALU
Credential	:	MD
Telephone Number	:	818-618-3728

Provider Enumeration Date	:	04/14/2021
Last Update Date	:	12/31/2021

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