Provider Demographics
NPI:1548526494
Name:OGUN, OMOLADE (MD)
Entity type:Individual
Prefix:DR
First Name:OMOLADE
Middle Name:
Last Name:OGUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:OMOLADE
Other - Middle Name:
Other - Last Name:AKINSANYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 20471
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-0471
Mailing Address - Country:US
Mailing Address - Phone:310-465-8448
Mailing Address - Fax:
Practice Address - Street 1:4676 ADMIRALTY WAY FL 4
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6601
Practice Address - Country:US
Practice Address - Phone:310-306-6966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine