Provider Demographics
NPI:1467599605
Name:MBAGWU, K N SOLOMON (MD)
Entity Type:Individual
Prefix:DR
First Name:K N
Middle Name:SOLOMON
Last Name:MBAGWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1218 S INGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-3649
Mailing Address - Country:US
Mailing Address - Phone:310-672-4881
Mailing Address - Fax:310-672-9887
Practice Address - Street 1:1218 S INGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-3649
Practice Address - Country:US
Practice Address - Phone:310-672-4881
Practice Address - Fax:310-672-9887
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG42217207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G422171Medicaid
CA00G422171Medicaid
CAA48863Medicare ID - Type Unspecified