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General NPI Number Information
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NPI Number | 1679968077
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Entity Type | Individual
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Provider Name | IVIE O OKUNDAYE MD
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Gender | Female
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 05/09/2024
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Provider Practice Location Address
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Address Line | 795 EL CAMINO REAL
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City | PALO ALTO
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State | CA
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Zip | 94301-2302
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Country | US
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Telephone | 650-321-4121
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Fax |
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Provider Business Mailing Address
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Address Line | 325 DISTEL CIR
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City | LOS ALTOS
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State | CA
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Zip | 94022-1408
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Country | US
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Telephone | 650-321-4121
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 036168318
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 23179
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A156582
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License Number State | CA
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