Provider Demographics
NPI:1255630083
Name:OGOH, KINGSLEY
Entity type:Individual
Prefix:
First Name:KINGSLEY
Middle Name:
Last Name:OGOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 THE RESORT PKWY UNIT 2316
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-9226
Mailing Address - Country:US
Mailing Address - Phone:770-845-4536
Mailing Address - Fax:
Practice Address - Street 1:11541 LAUREL CANYON BLVD STE C
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4602
Practice Address - Country:US
Practice Address - Phone:818-365-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist