Provider Demographics
NPI:1477849461
Name:OGUAYO, KEVIN NNAEMEKA (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:NNAEMEKA
Last Name:OGUAYO
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 1:17903 W LAKE HOUSTON PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3954
Mailing Address - Country:US
Mailing Address - Phone:281-446-7173
Mailing Address - Fax:832-644-5459
Practice Address - Street 1:17903 W LAKE HOUSTON PKWY STE 201
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3954
Practice Address - Country:US
Practice Address - Phone:281-446-7173
Practice Address - Fax:832-644-5459
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3564207R00000X, 207RC0000X, 207RI0011X, 207RI0011X
TN58408207RC0000X
NJ25MA10552000207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ3564OtherTMB
TNQ043786Medicaid