Provider Demographics
NPI:1144545435
Name:KUYINU, ISRAELDIVINE OLA (PHD, MHS, PA-C)
Entity type:Individual
Prefix:DR
First Name:ISRAELDIVINE
Middle Name:OLA
Last Name:KUYINU
Suffix:
Gender:M
Credentials:PHD, MHS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8130 MORNING ROSE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-4954
Mailing Address - Country:US
Mailing Address - Phone:281-830-2533
Mailing Address - Fax:
Practice Address - Street 1:8130 MORNING ROSE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-4954
Practice Address - Country:US
Practice Address - Phone:346-624-7207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X, 175L00000X
TXPA06693363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No175F00000XOther Service ProvidersNaturopath
No175L00000XOther Service ProvidersHomeopath
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12116713OtherCAQH
TX288027002Medicaid
TX268077YKQHMedicare PIN