Provider Demographics
NPI:1437228400
Name:UDOH, NNAEMEKA CHRISTOPHER (M D)
Entity Type:Individual
Prefix:DR
First Name:NNAEMEKA
Middle Name:CHRISTOPHER
Last Name:UDOH
Suffix:
Gender:M
Credentials:M D
Other - Prefix:DR
Other - First Name:NNAEMEKA
Other - Middle Name:CHRISTOPHER
Other - Last Name:UDOH
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:M D
Mailing Address - Street 1:3314 W VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-5230
Mailing Address - Country:US
Mailing Address - Phone:323-298-0455
Mailing Address - Fax:323-298-0104
Practice Address - Street 1:3314 W VERNON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-5230
Practice Address - Country:US
Practice Address - Phone:323-298-0455
Practice Address - Fax:323-298-0104
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30452208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A304520Medicaid
CAC-35370Medicare UPIN