Basic Information
| Provider Information | |||||||||
| NPI: | 1285666826 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OGAN | ||||||||
| FirstName: | IKECHI | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26060 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074264883 | ||||||||
| FaxNumber: | 5594554007 | ||||||||
| Practice Location | |||||||||
| Address1: | 1860 PENNSYLVANIA AVE | ||||||||
| Address2: | STE 150 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074264883 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZF0201X | A70908 | CA | Y | Allopathic & Osteopathic Physicians | Pathology | Forensic Pathology |
No ID Information.