Individual
NDIKA FOMUKONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.C
Contact information
Practice address
6470 VAN NUYS BLVD STE D, VAN NUYS, CA 91401-1499
(323) 733-7242
(310) 975-1292
Mailing address
6470 VAN NUYS BLVD STE D, VAN NUYS, CA 91401-1499
(323) 733-7242
(310) 975-1292
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA17839
CA
363LP2300X
Primary Care Nurse Practitioner
Primary
NP 17180
CA
Other
Enumeration date
05/23/2006
Last updated
04/10/2026
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