Provider Demographics
NPI:1760917819
Name:CY-SAGE MEDICAL CLINIC
Entity Type:Organization
Organization Name:CY-SAGE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHADIJAT
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNBIYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-368-0596
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77410-1239
Mailing Address - Country:US
Mailing Address - Phone:281-815-3812
Mailing Address - Fax:833-217-0891
Practice Address - Street 1:16506 FM 529 RD STE 116
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095
Practice Address - Country:US
Practice Address - Phone:281-815-3812
Practice Address - Fax:281-815-3812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200613040AMedicaid