Provider Demographics
NPI:1689874067
Name:FIREMPONG, OWUSU ANANEH (MD)
Entity Type:Individual
Prefix:DR
First Name:OWUSU
Middle Name:ANANEH
Last Name:FIREMPONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:311 N ROBERTSON BLVD # 373
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1705
Mailing Address - Country:US
Mailing Address - Phone:714-434-9559
Mailing Address - Fax:714-434-9779
Practice Address - Street 1:11180 WARNER AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7501
Practice Address - Country:US
Practice Address - Phone:714-434-9559
Practice Address - Fax:714-434-9779
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG42397208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA89758Medicare UPIN
CAWG42397CMedicare PIN
CAWG42397BMedicare PIN