Provider Demographics
NPI:1902903552
Name:AGU, CHRISTOPHER KANAYO (N/A)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:KANAYO
Last Name:AGU
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 LONG BEACH BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3319
Mailing Address - Country:US
Mailing Address - Phone:562-426-3659
Mailing Address - Fax:562-492-1206
Practice Address - Street 1:3711 LONG BEACH BLVD STE 214
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3319
Practice Address - Country:US
Practice Address - Phone:562-426-3659
Practice Address - Fax:562-492-1206
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44820332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03398FMedicaid