Provider Demographics
NPI:1124474515
Name:ABISOGUN, KAREN CHINONSO KAGHA (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:CHINONSO KAGHA
Last Name:ABISOGUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 STANIFORD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2543
Mailing Address - Country:US
Mailing Address - Phone:617-726-2914
Mailing Address - Fax:
Practice Address - Street 1:9201 W SUNSET BLVD STE 602
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-3707
Practice Address - Country:US
Practice Address - Phone:310-246-0495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA283125207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program