Provider Demographics
NPI:1134657067
Name:BABAJIDE, LUKMANAFIS (MD)
Entity Type:Individual
Prefix:
First Name:LUKMANAFIS
Middle Name:
Last Name:BABAJIDE
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 1:2001 WILSHIRE BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5683
Mailing Address - Country:US
Mailing Address - Phone:855-427-2778
Mailing Address - Fax:424-322-1214
Practice Address - Street 1:2001 WILSHIRE BLVD STE 320
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5683
Practice Address - Country:US
Practice Address - Phone:855-427-2778
Practice Address - Fax:424-322-1214
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3097402084P0800X
390200000X
CAA1781952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program