Adegbenga A Adetola, MD

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

A55507 Issued in CA

Practice address

3591 East Imperial Highway
Suite 1
Lynwood, CA 90262

Phone

(310) 631-2838

Fax

(310) 632-4701

NPI assigned

Oct 19, 2006

Last updated

Jun 11, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Adegbenga a Adetola M D Inc

  • Nephrology Physician
  • Lynwood, CA
  • NPI 1205152139
  Medicare reassignment NPD
• KND Development 59 LLC

  • Hospitalist Physician
  • Santa Ana, CA
  • NPI 1740519081
  Medicare reassignment NPD
• All Saints Outpatient Center

  • Child Intellectual and/or Developmental Disabilities Respite Care
  • Lynwood, CA
  • NPI 1972830792
  Authorized official Same address or phone
• KND Development 59 LLC

  • Hospitalist Physician
  • Baldwin Park, CA
  • NPI 1154626315
  NPD
• KND Development 59, LLC

  dba Specialty Hospitals Broken Arrow

  • Hospitalist Physician
  • Broken Arrow, OK
  • NPI 1922950823
  NPD
• A-1 Hospice Care Inc

  • Community Based Hospice Care Agency
  • Burbank, CA
  • NPI 1871838276
  NPD (past)
• Intel Healthcare LLC

  dba Intel Ambulance Service

  • Ambulance
  • Anaheim, CA
  • NPI 1235502949
  NPD (past)

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213142400000",
    "number": "1881776219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3591 EAST IMPERIAL HIGHWAY",
            "address_2": "SUITE 1",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "90262",
            "telephone_number": "310-631-2838",
            "fax_number": "310-632-4701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3591 EAST IMPERIAL HIGHWAY",
            "address_2": "SUITE 1",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "90262",
            "telephone_number": "310-631-2838",
            "fax_number": "310-632-4701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADETOLA",
        "first_name": "ADEGBENGA",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2008-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A55507",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A555070",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jilbert Abnoosian, PA
• Nellie M Acevedo, RDA
• Mayra Aceves
• Addiction Research and Treatment, Inc (BAART Programs Lynwood)
• Adegbenga a Adetola M D Inc
• Ag Lynwood, LLC (Lynwood Healthcare Center)
• Arlet Agazaryan, D.C.
• Brisa Aidee Aguilar
• Ruben Aguilera
• Ji Won Ahn

• Nephrology Physician in Lynwood, CA
• Providers in Lynwood, CA by specialty
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; 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.