Provider Demographics
NPI:1336938240
Name:OMNI WOUND PHYSICIANS SD PLLC
Entity type:Organization
Organization Name:OMNI WOUND PHYSICIANS SD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:OKEMEFUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKPARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-228-3538
Mailing Address - Street 1:25044 PEACHLAND AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-5730
Mailing Address - Country:US
Mailing Address - Phone:661-649-4713
Mailing Address - Fax:
Practice Address - Street 1:101 S REID ST STE 307
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-7045
Practice Address - Country:US
Practice Address - Phone:213-228-3538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty