Healthcare Provider Details

I. General information

NPI: 1891271276
Provider Name (Legal Business Name): ABAYOMI OLUWASEUN BAMGBOJE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 ENSIGN RD NE STE K
OLYMPIA WA
98506-5065
US

IV. Provider business mailing address

3525 ENSIGN RD NE STE K
OLYMPIA WA
98506-5065
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-8121
  • Fax: 360-413-8865
Mailing address:
  • Phone: 360-413-8121
  • Fax: 360-413-8865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number70146407
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: