Provider Demographics
NPI:1043879281
Name:CHUKSORJI, BRENDA CHINENYE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:CHINENYE
Last Name:CHUKSORJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 JOHN MUIR PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5183
Mailing Address - Country:US
Mailing Address - Phone:925-727-6978
Mailing Address - Fax:
Practice Address - Street 1:350 JOHN MUIR PKWY STE 105
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5183
Practice Address - Country:US
Practice Address - Phone:925-727-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA180802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine