Provider Demographics
NPI:1417192063
Name:CHUKWUDI, UCHE AUSTINE (MD)
Entity Type:Individual
Prefix:
First Name:UCHE
Middle Name:AUSTINE
Last Name:CHUKWUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 W 134TH PL
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-1644
Mailing Address - Country:US
Mailing Address - Phone:213-595-6224
Mailing Address - Fax:
Practice Address - Street 1:15425 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4523
Practice Address - Country:US
Practice Address - Phone:310-355-1445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105496207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine