Provider Demographics
NPI:1962961805
Name:NWACHUKU, IKENNA BEN (MD)
Entity type:Individual
Prefix:
First Name:IKENNA
Middle Name:BEN
Last Name:NWACHUKU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E CHEVY CHASE DR STE 204
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4199
Mailing Address - Country:US
Mailing Address - Phone:323-409-7409
Mailing Address - Fax:
Practice Address - Street 1:1500 E CHEVY CHASE DR STE 204
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4199
Practice Address - Country:US
Practice Address - Phone:323-409-7409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA181903207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine