Healthcare Provider Details

I. General information

NPI: 1831655596
Provider Name (Legal Business Name): KONYINSOLA IYANIWURA DAWODU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 CAPITOL AVE DEPT 304
SACRAMENTO CA
95816-6006
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 916-262-9414
  • Fax:
Mailing address:
  • Phone: 760-830-2904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA207735
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0101270624
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101270624
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: