Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ndika Fomukong, PAC

Individual provider Primary Care Nurse Practitioner · NPI 1497700066

Ndika Fomukong, PAC is a Primary Care Nurse Practitioner in Van Nuys, California. Licensed in California. Registered with an NPI since 2006.

Licensed in
CA
In the registry since
2006
Specialties on file
2
What do these letters mean?
PAC — Physician Assistant, Certified
A physician assistant holding current national certification; usually written PA-C.

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Practice location Address checks out

6470 Van Nuys Blvd Ste D
Van Nuys, CA 91401-1499
Phone: (323) 733-7242
Fax: (310) 975-1292
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Primary Care Nurse Practitioner (primary) Taxonomy 363LP2300X · Licence NP 17180 (CA)
Physician Assistant Taxonomy 363A00000X · Licence PA17839 (CA)

Record details

NPI number1497700066
Entity typeIndividual (Type 1)
GenderMale
Credentials PAC
Sole proprietorNo
NPI enumeratedMay 23, 2006
Last updated in NPPESApril 10, 2026
Certification dateApril 10, 2026

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