Provider Demographics
NPI:1952594053
Name:OBIECHINA, NKEMJIKA SUSAN
Entity Type:Individual
Prefix:DR
First Name:NKEMJIKA
Middle Name:SUSAN
Last Name:OBIECHINA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:NKEM
Other - Middle Name:SUSAN
Other - Last Name:OBIECHINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:1851 SUTTER ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2559
Mailing Address - Country:US
Mailing Address - Phone:925-827-2798
Mailing Address - Fax:
Practice Address - Street 1:1851 SUTTER ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2559
Practice Address - Country:US
Practice Address - Phone:925-827-2798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA579031223P0300X
NY0480341223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics