Basic Information
| Provider Information | |||||||||
| NPI: | 1003005661 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OKETOKUN | ||||||||
| FirstName: | ADEFOLAJU | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | OLUFUWA | ||||||||
| OtherFirstName: | ADEFOLAJU | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 91280 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200901280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2026365136 | ||||||||
| FaxNumber: | 2026365137 | ||||||||
| Practice Location | |||||||||
| Address1: | 1629 K STREET NW | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200061631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2026361360 | ||||||||
| FaxNumber: | 2026365137 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2007 | ||||||||
| LastUpdateDate: | 08/17/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0401X | D0084292 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 208D00000X | C1-0008405 | DE | N | Allopathic & Osteopathic Physicians | General Practice | 207RA0401X | MD038372 | DC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 261Q00000X | MD430487 | PA | N | Ambulatory Health Care Facilities | Clinic/Center | 261Q00000X | MD 038372 | DC | N | Ambulatory Health Care Facilities | Clinic/Center | 207RA0401X | 0101262019 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 261QU0200X | MD 038372 | DC | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 332B00000X | MD038372 | DC | N | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 040597500 | 05 | DC | MEDICAID |