Provider Demographics
NPI:1548649726
Name:OKOCHA, ENENIZIAOGOCHUKWU (MD)
Entity type:Individual
Prefix:
First Name:ENENIZIAOGOCHUKWU
Middle Name:
Last Name:OKOCHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 5TH ST STE 405
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1541
Mailing Address - Country:US
Mailing Address - Phone:415-231-5333
Mailing Address - Fax:415-231-5332
Practice Address - Street 1:650 5TH ST STE 405
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1541
Practice Address - Country:US
Practice Address - Phone:415-231-5333
Practice Address - Fax:415-231-5332
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01082920A207Q00000X
CAA171609207Q00000X
390200000X
MN60851207Q00000X
IL036.150738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program