Provider Demographics
NPI:1770135212
Name:IHEOMA NWAOGU MD INC
Entity type:Organization
Organization Name:IHEOMA NWAOGU MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IHEOMA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:NWAOGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-540-3636
Mailing Address - Street 1:320 DARDANELLI LN STE 23B
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1441
Mailing Address - Country:US
Mailing Address - Phone:408-540-3636
Mailing Address - Fax:
Practice Address - Street 1:320 DARDANELLI LN STE 23B
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1441
Practice Address - Country:US
Practice Address - Phone:408-540-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-15
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty