Provider Demographics
NPI:1962051052
Name:KEHINDE, OLUWASEYI
Entity type:Individual
Prefix:MRS
First Name:OLUWASEYI
Middle Name:
Last Name:KEHINDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 MONARCH FALLS LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-1872
Mailing Address - Country:US
Mailing Address - Phone:770-608-6910
Mailing Address - Fax:281-933-2302
Practice Address - Street 1:6111 GLADEWELL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-1501
Practice Address - Country:US
Practice Address - Phone:281-933-2300
Practice Address - Fax:271-933-2302
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012556208000000X, 2080P0006X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01-0814149Medicaid