Provider Demographics
NPI:1083147979
Name:KEHINDE, AUGUSTINE ABIODUN
Entity Type:Individual
Prefix:
First Name:AUGUSTINE
Middle Name:ABIODUN
Last Name:KEHINDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AUGUSTINE
Other - Middle Name:ABIODUN
Other - Last Name:KEHINDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:43129 LEMONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-4724
Mailing Address - Country:US
Mailing Address - Phone:818-304-4243
Mailing Address - Fax:661-943-8076
Practice Address - Street 1:43129 LEMONWOOD DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-4724
Practice Address - Country:US
Practice Address - Phone:818-304-4243
Practice Address - Fax:661-943-8076
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006453363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner