Provider Demographics
NPI:1225209372
Name:DANIEL CHUKWU
Entity Type:Organization
Organization Name:DANIEL CHUKWU
Other - Org Name:THE ANGEL MEDICAL DISTRIBUTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-675-4666
Mailing Address - Street 1:14023 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-9255
Mailing Address - Country:US
Mailing Address - Phone:310-675-4666
Mailing Address - Fax:310-675-4004
Practice Address - Street 1:14023 CRENSHAW BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-9255
Practice Address - Country:US
Practice Address - Phone:310-675-4666
Practice Address - Fax:310-675-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102873332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4809150001OtherMEDICARE PROVIDER NUMBER
CA4809150001Medicare NSC