Provider Demographics
NPI:1730757733
Name:OCHIENG, CHRISTOPHER OMONDI
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:OMONDI
Last Name:OCHIENG
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 1:13367 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92344-4789
Mailing Address - Country:US
Mailing Address - Phone:949-295-2972
Mailing Address - Fax:
Practice Address - Street 1:2501 W BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2347
Practice Address - Country:US
Practice Address - Phone:818-856-9535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59624363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant