Provider Demographics
NPI:1841310125
Name:CHIDUEME, EMMANUEL CHINWE
Entity type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:CHINWE
Last Name:CHIDUEME
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 1:1304 S MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-5118
Mailing Address - Country:US
Mailing Address - Phone:714-484-9446
Mailing Address - Fax:714-484-1571
Practice Address - Street 1:1304 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5118
Practice Address - Country:US
Practice Address - Phone:714-484-9446
Practice Address - Fax:714-484-1571
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4504180001Medicare PIN