Healthcare Provider Details

I. General information

NPI: 1336400530
Provider Name (Legal Business Name): JEAN PAUL NGIEFONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEW YORK AVE NE STE 110
WASHINGTON DC
20002-1849
US

IV. Provider business mailing address

1818 NEW YORK AVE NE STE 228
WASHINGTON DC
20002-1851
US

V. Phone/Fax

Practice location:
  • Phone: 202-489-0615
  • Fax:
Mailing address:
  • Phone: 412-219-9121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: