Basic Information
Provider Information | |||||||||
NPI: | 1528422508 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | OGBONNAH | ||||||||
FirstName: | UZOAMAKA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1708 YAKIMA AVE STE 300 | ||||||||
Address2: |   | ||||||||
City: | TACOMA | ||||||||
State: | WA | ||||||||
PostalCode: | 984055309 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2533638700 | ||||||||
FaxNumber: | 2532720419 | ||||||||
Practice Location | |||||||||
Address1: | 1708 YAKIMA AVE STE 300 | ||||||||
Address2: |   | ||||||||
City: | TACOMA | ||||||||
State: | WA | ||||||||
PostalCode: | 984055309 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2533638700 | ||||||||
FaxNumber: | 2532720419 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/06/2016 | ||||||||
LastUpdateDate: | 09/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/21/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | MD61274435 | WA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207R00000X | 312440 | LA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RC0200X | MD61274435 | WA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 390200000X |   | NM | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   |
ID Information
ID | Type | State | Issuer | Description | 312440 | 01 | LA | LICENSE NUMBER | OTHER | 2211684 | 05 | WA |   | MEDICAID |