Provider Demographics
NPI:1932369824
Name:AKWO, GEORGE ELONGE
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ELONGE
Last Name:AKWO
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 1:2118 WILSHIRE BLVD
Mailing Address - Street 2:#1010
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5784
Mailing Address - Country:US
Mailing Address - Phone:310-435-9406
Mailing Address - Fax:310-496-2458
Practice Address - Street 1:2118 WILSHIRE BLVD
Practice Address - Street 2:#1010
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5784
Practice Address - Country:US
Practice Address - Phone:310-435-9406
Practice Address - Fax:310-496-2458
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor