Provider Demographics
NPI:1598838963
Name:KAMSON, ADETOKUNBO (MD)
Entity Type:Individual
Prefix:DR
First Name:ADETOKUNBO
Middle Name:
Last Name:KAMSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TOKS
Other - Middle Name:
Other - Last Name:KAMSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1102
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90267-1102
Mailing Address - Country:US
Mailing Address - Phone:310-850-2448
Mailing Address - Fax:310-793-8387
Practice Address - Street 1:2710 W MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-2436
Practice Address - Country:US
Practice Address - Phone:323-778-4310
Practice Address - Fax:323-778-0838
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2012-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA043596208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE99168Medicare UPIN