Bennet Ifeakandu Omalu, M.D., M.B.A., M.P.H.

Primary specialty

Independent Medical Examiner PhysicianTaxonomy code 202C00000X

License

C52868 Issued in CA

Practice address

4400 V Street
University of California, Davis, Medical Center
Sacramento, CA 95817

Phone

(916) 734-2525

Fax

(866) 402-6875

NPI assigned

Apr 19, 2007

Last updated

Mar 23, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 7

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration, Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584921600000",
    "number": "1346467370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3031 W MARCH LN STE 323",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952196578",
            "telephone_number": "092-636-2822",
            "fax_number": "866-402-6875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 V STREET",
            "address_2": "UNIVERSITY OF CALIFORNIA, DAVIS, MEDICAL CENTER",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "95817",
            "telephone_number": "916-734-2525",
            "fax_number": "866-402-6875"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3031 W March Ln Ste 323",
            "address_purpose": "LOCATION",
            "city": "Stockton",
            "state": "CA",
            "postal_code": "952196578",
            "country_code": "US",
            "telephone_number": "092-636-2822",
            "fax_number": "866-402-6875",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OMALU",
        "first_name": "BENNET",
        "middle_name": "IFEAKANDU",
        "name_prefix": "Dr.",
        "credential": "M.D., M.B.A., M.P.H.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-19",
        "last_updated": "2020-03-23",
        "certification_date": "2020-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZF0201X",
            "taxonomy_group": "",
            "desc": "Pathology, Forensic Pathology",
            "state": "CA",
            "license": "C52868",
            "primary": false
        },
        {
            "code": "207ZN0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Neuropathology",
            "state": "CA",
            "license": "C52868",
            "primary": false
        },
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "CA",
            "license": "C52868",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "C52868",
            "primary": false
        },
        {
            "code": "209800000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "CA",
            "license": "C52868",
            "primary": false
        },
        {
            "code": "207ZC0006X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology",
            "state": "CA",
            "license": "C52868",
            "primary": false
        },
        {
            "code": "202C00000X",
            "taxonomy_group": "",
            "desc": "Independent Medical Examiner",
            "state": "CA",
            "license": "C52868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joan Olveda, RN
• Nancy Olvera Zamudio
• Michael Patrick Olvera, MD
• Katelin Olympius
• Robert James Omalley, NP
• Thomas More Omeara, LCSW
• Amina Omer
• Julie Omishakin, NP
• Prince Omogun
• White Omogun

• Independent Medical Examiner Physician in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Independent Medical Examiner Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.