Active NPI
Tinyan Okunbo, MD
- Pediatrics Physician
- Anaheim, CA
National Provider Identifier
1730435280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- C50892
- Practice address
- 820 S Cottontail LN
Anaheim, CA 92808-1409 - Phone
- (714) 858-3109
- Fax
- (714) 280-8504
- NPI assigned
- Aug 1, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | C50892 | CA | Primary |
| General Practice Physician | 208D00000X | C50892 | CA |
Addresses
Primary practice location
820 S Cottontail LN
Anaheim, CA 92808-1409
Mailing address
4924 Balboa Blvd
356
Encino, CA 91316-3402
Phone (818) 300-4308
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C50892 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343779200000",
"number": "1730435280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4924 BALBOA BLVD",
"address_2": "356",
"city": "ENCINO",
"state": "CA",
"postal_code": "913163402",
"telephone_number": "818-300-4308",
"fax_number": "714-280-8504"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 S COTTONTAIL LN",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928081409",
"telephone_number": "714-858-3109",
"fax_number": "714-280-8504"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OKUNBO",
"first_name": "TINYAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-01",
"last_updated": "2012-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "C50892",
"primary": true
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "CA",
"license": "C50892",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.