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NPI Code Detail

MEDICARE: K N SOLOMON MBAGWU MD INC. A PROFESSIONAL MEDICAL GROUP

MEDICARE: K N SOLOMON MBAGWU MD INC. A PROFESSIONAL MEDICAL GROUP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology PhysicianG42217CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831236959
Entity Type Code : Organization
Provider Name (Legal Business Name) : K N SOLOMON MBAGWU MD INC. A PROFESSIONAL MEDICAL GROUP
Provider Business Mailing Address
First Line : 10024 S VERMONT AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-3112
Country : US
Telephone Number : 323-242-0139
Fax Number : 323-242-0149
Provider Business Practice Location Address
First Line : 10024 S VERMONT AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-3112
Country : US
Telephone Number : 323-242-0139
Fax Number : 323-242-0149
Authorized Official
Title or Position : PRESIDENT
Name : DR. K.N. SOLOMON MBAGWU
Credential : M.D.
Telephone Number : 310-672-4881
Provider Enumeration Date : 01/30/2007
Last Update Date : 06/06/2008

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