Healthcare Provider Details

I. General information

NPI: 1619078532
Provider Name (Legal Business Name): DOTUN ADEBOYE OGUNYEMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PEPPER AVE
COLTON CA
92324-1819
US

IV. Provider business mailing address

900 W OLYMPIC BLVD UNIT 32D
LOS ANGELES CA
90015-1344
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-3484
  • Fax:
Mailing address:
  • Phone: 310-279-3538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301104263
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA43245
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number4301104263
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberA42345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: