Provider Demographics
NPI:1306174479
Name:UCHENNA A. OKORONKWO II, MD. INC.
Entity type:Organization
Organization Name:UCHENNA A. OKORONKWO II, MD. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:UCHENNA
Authorized Official - Middle Name:AMARAMIRO
Authorized Official - Last Name:OKORONKWO
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:510-569-7326
Mailing Address - Street 1:10500 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-5248
Mailing Address - Country:US
Mailing Address - Phone:510-569-7326
Mailing Address - Fax:510-569-7329
Practice Address - Street 1:10500 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-5248
Practice Address - Country:US
Practice Address - Phone:510-569-7326
Practice Address - Fax:510-569-7329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55275261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center