Kellon Olusola, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

A207193 Issued in CA

Practice address

4934 Verdugo Way
Camarillo, CA 93012-8631

Phone

(866) 944-6046

Fax

(805) 388-2174

NPI assigned

Sep 5, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1662336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787702400000",
    "number": "1801517313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4934 VERDUGO WAY",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930128631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4934 VERDUGO WAY",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930128631",
            "telephone_number": "866-944-6046",
            "fax_number": "805-388-2174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLUSOLA",
        "first_name": "KELLON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-05",
        "last_updated": "2026-08-26",
        "certification_date": "2026-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A207193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dianna Oliver
• Kristal Linette Oliveros, LVN
• Brianna Olmo
• Lynn Marie Olson, MSN, CNM, WHNP
• Patricia Olson
• Omega Edwards MD Inc
• Gilbert Onaka, M.D.
• Lori Oneal
• Tracy S Opp, C.A.T.C.
• Tiffani Oppenheim, M.A.

• General Practice Physician in Camarillo, CA
• Providers in Camarillo, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.