| Doctor Name: | TINYAN OKUNBO |
| NPI Number: | 1730435280 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | C50892 |
| Business Practice Address: | 820 S Cottontail Ln Anaheim, CA - 928081409 |
| Business Phone Number: | 7148583109 |
| Business Fax Number: | 7142808504 |
| Mailing Address: | 4924 Balboa Blvd, 356 ENCINO |
| State: | CA |
| Postal Code: | 913163402 |
| Phone Number: | 8183004308 |
| Fax Number: | 7142808504 |
| NPI Enumeration Date: | 08/01/2012 |
| NPI Last Update Date: | 08/01/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | C50892 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |