Provider Demographics
NPI:1073530911
Name:CHRIS NGOZI OGWONUWE
Entity Type:Organization
Organization Name:CHRIS NGOZI OGWONUWE
Other - Org Name:WISDOM & KIM MEDICAL SUPPLY COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:NGOZI
Authorized Official - Last Name:OGWONUWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-649-5002
Mailing Address - Street 1:8631 TRUXTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3910
Mailing Address - Country:US
Mailing Address - Phone:310-649-5002
Mailing Address - Fax:310-216-2874
Practice Address - Street 1:8631 TRUXTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3910
Practice Address - Country:US
Practice Address - Phone:310-649-5002
Practice Address - Fax:310-216-2874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4670910001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4670910001Medicare ID - Type UnspecifiedPROVIDER NUMBER