Provider Demographics
NPI:1497960819
Name:OKORONKWO MEDICAL CORP OF ALAMEDA
Entity Type:Organization
Organization Name:OKORONKWO MEDICAL CORP OF ALAMEDA
Other - Org Name:OKORONKWO MEDICAL CORP. OF ALAMEDA COUNTY INC. (OMCAC)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:UCHENNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:OKORONKWO
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:510-569-7326
Mailing Address - Street 1:10500 MACARTHUR BLVD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-5248
Mailing Address - Country:US
Mailing Address - Phone:510-569-7326
Mailing Address - Fax:510-569-7329
Practice Address - Street 1:10500 MACARTHUR BLVD.
Practice Address - Street 2:SUITE #102
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-5248
Practice Address - Country:US
Practice Address - Phone:510-569-7326
Practice Address - Fax:510-569-7329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
CAG55275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty