Provider Demographics
NPI:1205802428
Name:OKPARA, OKEMEFUNA I (MD)
Entity type:Individual
Prefix:
First Name:OKEMEFUNA
Middle Name:I
Last Name:OKPARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25044 PEACHLAND AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-5730
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28212 KELLY JOHNSON PKWY STE 200
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5090
Practice Address - Country:US
Practice Address - Phone:213-228-3538
Practice Address - Fax:213-223-8912
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3957207P00000X, 208600000X
NY236058-1207P00000X
CAA99029207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A990290Medicaid
NY02691743Medicaid
CAWA99029BMedicare PIN
CAWA99029AMedicare PIN
CA00A990290Medicaid
NY02691743Medicaid