Provider Demographics
NPI:1023212982
Name:UKATU, CHIDI JUDE (MD)
Entity Type:Individual
Prefix:
First Name:CHIDI
Middle Name:JUDE
Last Name:UKATU
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 1:10521 RUTHELEN ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-4341
Mailing Address - Country:US
Mailing Address - Phone:310-701-8216
Mailing Address - Fax:
Practice Address - Street 1:10521 RUTHELEN ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-4341
Practice Address - Country:US
Practice Address - Phone:310-701-8216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60855728208600000X
CAA101948208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery