1235213554 NPI number — DR. ALOYSIUS IFEANYI UDEZE DC, BSC, IDE, DABDA.

Table of content: (NPI 1104442698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235213554 NPI number — DR. ALOYSIUS IFEANYI UDEZE DC, BSC, IDE, DABDA.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UDEZE
Provider First Name:
ALOYSIUS
Provider Middle Name:
IFEANYI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC, BSC, IDE, DABDA.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
UDEZE
Provider Other First Name:
AL
Provider Other Middle Name:
I.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235213554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11012 CHANERA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INGLEWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90303-2427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-390-9293
Provider Business Mailing Address Fax Number:
323-820-1718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12613 VENICE BLVD
Provider Second Line Business Practice Location Address:
13523 LEMOLI AVENUE HAWTHORNE, CA 90250
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90066-3703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-390-9293
Provider Business Practice Location Address Fax Number:
323-820-1718
Provider Enumeration Date:
10/24/2006

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: 111N00000X , with the licence number:  DC24645 , 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)

  • Identifier: WDC24645B CA . This is a "MEDICARE W18417 CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ64099Z . This is a "ZZZ64099Z CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DC0246450 . This is a "DOCTOR'S BLUE SHIELD PIN#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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