Provider Demographics
NPI:1780330233
Name:CHIMA, SOPURUCHUKWU OGECHI (DDS)
Entity type:Individual
Prefix:
First Name:SOPURUCHUKWU
Middle Name:OGECHI
Last Name:CHIMA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12311 PACIFIC AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-4421
Mailing Address - Country:US
Mailing Address - Phone:559-349-0216
Mailing Address - Fax:
Practice Address - Street 1:3131 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5839
Practice Address - Country:US
Practice Address - Phone:323-835-6839
Practice Address - Fax:323-585-5277
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1065931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice