MEDICARE: MICHAEL OKONKWO

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	332B00000X	Durable Medical Equipment & Medical Supplies	103060	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	103060	OTHER	CA	HMDR

General Provider Information

NPI Number	:	1881794378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL OKONKWO

Provider Business Mailing Address
First Line	:	6109 S WESTERN AVE STE 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-1454
Country	:	US
Telephone Number	:	323-752-0746
Fax Number	:	323-752-0834

Provider Business Practice Location Address
First Line	:	6109 S WESTERN AVE STE 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-1454
Country	:	US
Telephone Number	:	323-752-0746
Fax Number	:	323-752-0834

Authorized Official
Title or Position	:	OWNER
Name	:	MR. NNAEMEKA MICHAEL OKONKWO
Credential	:
Telephone Number	:	323-752-0746

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	06/26/2008

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Directions to “MICHAEL OKONKWO ” Practice Location

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