Provider Demographics
NPI:1801806674
Name:ARENE, IKECHUKWU (MD)
Entity type:Individual
Prefix:
First Name:IKECHUKWU
Middle Name:
Last Name:ARENE
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 1:11325 PARK SQUARE DR APT K202
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-8869
Mailing Address - Country:US
Mailing Address - Phone:661-873-5887
Mailing Address - Fax:
Practice Address - Street 1:5400 BALBOA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5200
Practice Address - Country:US
Practice Address - Phone:818-290-3289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51962207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C519620Medicaid
CABL618ZMedicare PIN
CA00C519620Medicaid
CAG01902Medicare UPIN
CAAQ463VMedicare PIN