Healthcare Provider Details

I. General information

NPI: 1447994793
Provider Name (Legal Business Name): DOTUN OGUNYEMI MD INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST STE 444E
LOS ANGELES CA
90048-5908
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 310-652-8141
  • Fax:
Mailing address:
  • Phone: 310-279-3538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DOTUN OGUNYEMI MD OGUNYEMI
Title or Position: PHYSICIAN
Credential: MD
Phone: 310-279-3538