Provider Demographics
NPI:1447994793
Name:DOTUN OGUNYEMI MD INCORPORATED
Entity type:Organization
Organization Name:DOTUN OGUNYEMI MD INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DOTUN OGUNYEMI MD
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-279-3538
Mailing Address - Street 1:900 W OLYMPIC BLVD UNIT 32D
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1344
Mailing Address - Country:US
Mailing Address - Phone:310-279-3538
Mailing Address - Fax:
Practice Address - Street 1:8631 W 3RD ST STE 444E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5908
Practice Address - Country:US
Practice Address - Phone:310-652-8141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-22
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA800361660Medicaid