Healthcare Provider Details

I. General information

NPI: 1598792657
Provider Name (Legal Business Name): JOSEPH O AIYENOWO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 SE BISHOP BLVD STE 200
PULLMAN WA
99163-5537
US

IV. Provider business mailing address

PO BOX 609 705 E RANDALL
HESSTON KS
67062
US

V. Phone/Fax

Practice location:
  • Phone: 509-332-2517
  • Fax: 509-334-9247
Mailing address:
  • Phone: 620-327-2440
  • Fax: 620-327-2062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-27421
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60992612
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60992612
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0427421
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: