Provider Demographics
NPI:1508392457
Name:DIKE, UZOAMAKA KIMBERLY EZENDU (MD)
Entity type:Individual
Prefix:DR
First Name:UZOAMAKA
Middle Name:KIMBERLY EZENDU
Last Name:DIKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6431 FANNIN ST
Mailing Address - Street 2:SUITE MSB 1.134
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-500-6500
Mailing Address - Fax:713-500-6497
Practice Address - Street 1:1919 SANTA MONICA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1955
Practice Address - Country:US
Practice Address - Phone:310-453-1871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA196333207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program