Healthcare Provider Details

I. General information

NPI: 1295992063
Provider Name (Legal Business Name): TEMITAYO OYEGBILE CHIDI MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TEMITAYO OYEFUNMIKE OYEGBILE MD, PHD

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-703-5514
  • Fax:
Mailing address:
  • Phone: 916-734-3588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberC166590
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberC166590
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number0101250149
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberMD040137
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberD76678
License Number StateMD
# 6
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number0101250149
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: