1073392668 NPI number — IKECHI OKPARA

Table of content: IKECHI OKPARA (NPI 1073392668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073392668 NPI number — IKECHI OKPARA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OKPARA
Provider First Name:
IKECHI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073392668
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1774 ZONAL AVE. BUILDING A, SUITE 318
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90033-1317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-289-4100
Provider Business Mailing Address Fax Number:
855-638-8801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1774 ZONAL AVE STE 318
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-1063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-289-4100
Provider Business Practice Location Address Fax Number:
855-638-8801
Provider Enumeration Date:
09/25/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  18831 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 153426 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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