Provider Demographics
NPI:1629465273
Name:KINGSLEY O. OFOEGBU MD, FACP, INC
Entity Type:Organization
Organization Name:KINGSLEY O. OFOEGBU MD, FACP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEBASTINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHIKEZIE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:310-982-3141
Mailing Address - Street 1:20111 WADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3046
Mailing Address - Country:US
Mailing Address - Phone:310-982-3141
Mailing Address - Fax:
Practice Address - Street 1:644 E REGENT ST STE 200
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1444
Practice Address - Country:US
Practice Address - Phone:310-982-3141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA688400261QA0600X, 3140N1450X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric