Provider Demographics
NPI:1760566053
Name:DURU, CHIKA EBENEZER
Entity Type:Individual
Prefix:MR
First Name:CHIKA
Middle Name:EBENEZER
Last Name:DURU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 E PACIFIC COAST HWY STE F
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-1574
Mailing Address - Country:US
Mailing Address - Phone:562-986-4430
Mailing Address - Fax:562-597-7982
Practice Address - Street 1:2340 E PACIFIC COAST HWY STE F
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-1574
Practice Address - Country:US
Practice Address - Phone:562-986-4430
Practice Address - Fax:562-597-7982
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101338332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4454540001Medicare NSC