Provider Demographics
NPI:1497913735
Name:UDOH-ESOMONU, CHIKA PAMELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHIKA
Middle Name:PAMELLA
Last Name:UDOH-ESOMONU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHIKA
Other - Middle Name:PAMELLA
Other - Last Name:UDOH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:202 STONE PINE CT
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-2676
Mailing Address - Country:US
Mailing Address - Phone:510-691-1816
Mailing Address - Fax:510-245-3244
Practice Address - Street 1:901 CAMPUS DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4930
Practice Address - Country:US
Practice Address - Phone:650-991-2000
Practice Address - Fax:650-755-8638
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104151207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01039885Medicare PIN
CARES000Medicare UPIN
CAEO516XMedicare PIN