Provider Demographics
NPI:1508444852
Name:WACHUKU, CHINENYE DARLENE EDWINA (DPM)
Entity Type:Individual
Prefix:
First Name:CHINENYE
Middle Name:DARLENE EDWINA
Last Name:WACHUKU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16405 SAND CANYON AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3792
Mailing Address - Country:US
Mailing Address - Phone:949-651-1202
Mailing Address - Fax:
Practice Address - Street 1:16405 SAND CANYON AVE STE 270
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3792
Practice Address - Country:US
Practice Address - Phone:949-651-1202
Practice Address - Fax:949-552-9493
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAE6034213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program