Provider Demographics
NPI:1134856297
Name:BALOGUN, KEHINDE IDRIS (LVN)
Entity type:Individual
Prefix:
First Name:KEHINDE
Middle Name:IDRIS
Last Name:BALOGUN
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5232 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5710
Mailing Address - Country:US
Mailing Address - Phone:323-660-0900
Mailing Address - Fax:323-660-0771
Practice Address - Street 1:5232 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5710
Practice Address - Country:US
Practice Address - Phone:323-660-0900
Practice Address - Fax:323-660-0771
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA248701164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse