Provider Demographics
NPI:1336487925
Name:OSHUN, ADETUNJI HAKEEM (PA-C)
Entity Type:Individual
Prefix:
First Name:ADETUNJI
Middle Name:HAKEEM
Last Name:OSHUN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-3874
Mailing Address - Country:US
Mailing Address - Phone:972-975-5444
Mailing Address - Fax:469-666-9422
Practice Address - Street 1:916 W 6TH ST
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-3874
Practice Address - Country:US
Practice Address - Phone:972-975-5455
Practice Address - Fax:469-666-9422
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
TXPA08317363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant