Basic Information
| Provider Information | |||||||||
| NPI: | 1548729833 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EKPO | ||||||||
| FirstName: | ESON | ||||||||
| MiddleName: | PIUS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 PASTEUR DR | ||||||||
| Address2: | LANE 154 | ||||||||
| City: | STANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943055133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507236661 | ||||||||
| FaxNumber: | 6504986205 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 PASTEUR DR | ||||||||
| Address2: | LANE 154 | ||||||||
| City: | STANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943055133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507236661 | ||||||||
| FaxNumber: | 6504986205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2019 | ||||||||
| LastUpdateDate: | 03/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.