Organization
KINGHAVEN MEDICAL SYSTEM INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAMIDE OLAGUNDOYE (CFO)
(713) 457-3200
Entity
Organization
Contact information
Practice address
6335 GULFTON ST STE 103, SUITE 103, HOUSTON, TX 77081-1112
(713) 457-3200
Mailing address
6335 GULFTON ST STE 103, SUITE 103, HOUSTON, TX 77081-1112
(713) 457-3200
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3585879-01
—
TX
Enumeration date
03/05/2015
Last updated
08/01/2016
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