Healthcare Provider Details

I. General information

NPI: 1659651008
Provider Name (Legal Business Name): KEHINDE O OGUNMAKIN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 AUGUSTA DR
HOUSTON TX
77057
US

IV. Provider business mailing address

11511 SHADOW CREEK PKWY
PEARLAND TX
77584-7298
US

V. Phone/Fax

Practice location:
  • Phone: 713-442-2400
  • Fax:
Mailing address:
  • Phone: 713-442-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberQ2596
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: