Healthcare Provider Details

I. General information

NPI: 1750204087
Provider Name (Legal Business Name): OLUSESAN OJO OGUNDARE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 RIMLAND DR STE 301
BELLINGHAM WA
98226-8759
US

IV. Provider business mailing address

13800 HOWSER TRCE
MANOR TX
78653-2682
US

V. Phone/Fax

Practice location:
  • Phone: 253-922-4027
  • Fax:
Mailing address:
  • Phone: 347-513-6243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number70143250
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: