Provider Demographics
NPI:1023320512
Name:AJUWON, KEMISOLA OMOSEYE (MD)
Entity type:Individual
Prefix:DR
First Name:KEMISOLA
Middle Name:OMOSEYE
Last Name:AJUWON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 HAHLO ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77020-3022
Mailing Address - Country:US
Mailing Address - Phone:713-674-3326
Mailing Address - Fax:713-674-5100
Practice Address - Street 1:5808 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4923
Practice Address - Country:US
Practice Address - Phone:713-695-4013
Practice Address - Fax:713-674-5100
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXP8830208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP8830OtherTEXAS MEDICAL BOARD
TXP8830OtherTEXAS MEDICAL BOARD