Provider Demographics
NPI:1992759534
Name:NYENKE, CHINYERE ALICE (MD)
Entity type:Individual
Prefix:DR
First Name:CHINYERE
Middle Name:ALICE
Last Name:NYENKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHINYERE
Other - Middle Name:ALICE
Other - Last Name:UGBOAJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1776 W ADAMS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-2704
Mailing Address - Country:US
Mailing Address - Phone:323-732-4224
Mailing Address - Fax:323-732-4234
Practice Address - Street 1:1776 W ADAMS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-2704
Practice Address - Country:US
Practice Address - Phone:323-732-4224
Practice Address - Fax:323-732-4234
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74480207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH52164Medicare UPIN