Provider Demographics
NPI:1679150171
Name:ADEYEMI, ABAYOMI (MD)
Entity type:Individual
Prefix:DR
First Name:ABAYOMI
Middle Name:
Last Name:ADEYEMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 PINE AVE # 918
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4718
Mailing Address - Country:US
Mailing Address - Phone:424-343-6505
Mailing Address - Fax:323-370-0440
Practice Address - Street 1:65 PINE AVE # 918
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4718
Practice Address - Country:US
Practice Address - Phone:424-343-6505
Practice Address - Fax:323-370-0440
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA187667207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty