Healthcare Provider Details

I. General information

NPI: 1124474515
Provider Name (Legal Business Name): KAREN CHINONSO KAGHA ABISOGUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD STE 602
LOS ANGELES CA
90069-3707
US

IV. Provider business mailing address

50 STANIFORD ST STE 200
BOSTON MA
02114-2543
US

V. Phone/Fax

Practice location:
  • Phone: 310-246-0495
  • Fax:
Mailing address:
  • Phone: 617-726-2914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number283125
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: