Provider Demographics
NPI:1982989380
Name:OPOKU, EDWARD NANA JR (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:NANA
Last Name:OPOKU
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:3714 POTOMAC AVE # 106
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-5708
Mailing Address - Country:US
Mailing Address - Phone:213-389-2526
Mailing Address - Fax:213-389-2506
Practice Address - Street 1:2222 FOOTHILL BLVD # E122
Practice Address - Street 2:
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011-1456
Practice Address - Country:US
Practice Address - Phone:310-936-4782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A11418208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice