Provider Demographics
NPI:1992458608
Name:AKPENE GBEGNON MD, INC
Entity type:Organization
Organization Name:AKPENE GBEGNON MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AKPENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GBEGNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-433-8252
Mailing Address - Street 1:11209 NATIONAL BLVD # 158
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-3902
Mailing Address - Country:US
Mailing Address - Phone:310-433-8252
Mailing Address - Fax:
Practice Address - Street 1:6221 WILSHIRE BLVD STE 404
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5224
Practice Address - Country:US
Practice Address - Phone:310-433-8252
Practice Address - Fax:310-861-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty