Provider Demographics
NPI:1043885411
Name:KALU, JOHN AGWU
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:AGWU
Last Name:KALU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 SIX FORKS RD STE 205
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4465
Mailing Address - Country:US
Mailing Address - Phone:984-238-4248
Mailing Address - Fax:
Practice Address - Street 1:5300 SIX FORKS RD STE 205
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4465
Practice Address - Country:US
Practice Address - Phone:984-238-4248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
NCHC5847251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care