Provider Demographics
NPI:1528489770
Name:KALU, CHIDIMMA (MD)
Entity type:Individual
Prefix:
First Name:CHIDIMMA
Middle Name:
Last Name:KALU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:037-393-5468
Mailing Address - Fax:803-739-3546
Practice Address - Street 1:145 SUNSET CT STE 100
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-2429
Practice Address - Country:US
Practice Address - Phone:803-739-3550
Practice Address - Fax:803-739-3546
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA151058207Q00000X
NY318724207Q00000X
SC90653207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine