Provider Demographics
NPI:1073782520
Name:JONES, ABAYOMI S (MD)
Entity Type:Individual
Prefix:
First Name:ABAYOMI
Middle Name:S
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ABAYOMI
Other - Middle Name:S
Other - Last Name:HENDJE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1683
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94802-0683
Mailing Address - Country:US
Mailing Address - Phone:202-222-9664
Mailing Address - Fax:
Practice Address - Street 1:25800 CARLOS BEE BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94542-3000
Practice Address - Country:US
Practice Address - Phone:520-222-9664
Practice Address - Fax:202-269-7990
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD037390207Q00000X
MDD0073275207Q00000X, 207Q00000X
CAC134916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD232708ZDDB - 149619Medicare PIN
MD232708YVZ - 945LMedicare PIN