Provider Demographics
NPI:1003005661
Name:OKETOKUN, ADEFOLAJU (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEFOLAJU
Middle Name:
Last Name:OKETOKUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ADEFOLAJU
Other - Middle Name:
Other - Last Name:OLUFUWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 91280
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20090-1280
Mailing Address - Country:US
Mailing Address - Phone:202-636-5136
Mailing Address - Fax:202-636-5137
Practice Address - Street 1:1629 K STREET NW
Practice Address - Street 2:SUITE 300
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1631
Practice Address - Country:US
Practice Address - Phone:202-636-1360
Practice Address - Fax:202-636-5137
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0084292207RA0401X
DEC1-0008405208D00000X
DCMD038372207RA0401X, 332B00000X
PAMD430487261Q00000X
DCMD 038372261Q00000X, 261QU0200X
VA0101262019207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC040597500Medicaid