Provider Demographics
NPI:1275226789
Name:CHI DERMATOLOGY INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CHI DERMATOLOGY INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OGECHI
Authorized Official - Middle Name:
Authorized Official - Last Name:IKEDIOBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:941-315-1099
Mailing Address - Street 1:120 LA CASA VIA STE 106-107
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3067
Mailing Address - Country:US
Mailing Address - Phone:941-315-1099
Mailing Address - Fax:
Practice Address - Street 1:120 LA CASA VIA STE 106-107
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3067
Practice Address - Country:US
Practice Address - Phone:941-315-1099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty