Basic Information
| Provider Information | |||||||||
| NPI: | 1700381472 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AJE | ||||||||
| FirstName: | KENT | ||||||||
| MiddleName: | TOKUNBO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1725 W HARRISON ST STE 207 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606123988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129425861 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1725 W HARRISON ST STE 207 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606123988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129425861 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2018 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35.142039 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 125.072599 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 036.160514 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.