Provider Demographics
NPI:1154366946
Name:OBIOHA, UDOH O (MD)
Entity type:Individual
Prefix:DR
First Name:UDOH
Middle Name:O
Last Name:OBIOHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5633
Mailing Address - Country:US
Mailing Address - Phone:509-833-8330
Mailing Address - Fax:
Practice Address - Street 1:980 N D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410
Practice Address - Country:US
Practice Address - Phone:909-521-7509
Practice Address - Fax:909-521-7442
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42739207R00000X
ND9088207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND22032OtherNDBS #
ND75G13OBOtherMNBS #
ND21975OtherND MEDICARE #
ND60G20OBOtherMNBS #
NDND100060OtherLHS #
NDDA9011031164OtherPREFERRED ONE #
NDHP38210OtherHEALTHPARTNERS #
ND60G21OBOtherMNBS #
ND11892Medicaid
ND1622353OtherAMERICA'S PPO/ARAZ #
ND21975OtherND MEDICARE #
ND60G21OBOtherMNBS #
ND75G13OBOtherMNBS #
NDND100060OtherLHS #
ND1622353OtherAMERICA'S PPO/ARAZ #
E09101Medicare UPIN
ND21972Medicare ID - Type UnspecifiedND MEDICARE #
ND60G21OBOtherMNBS #
ND21975OtherND MEDICARE #
ND110242750Medicare ID - Type UnspecifiedRR MEDICARE #