Healthcare Provider Details

I. General information

NPI: 1528500378
Provider Name (Legal Business Name): WILLIAM NOEL NGONGANG NGASSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 MARTIN LUTHER KING JR AVE SW APT C202
WASHINGTON DC
20032
US

IV. Provider business mailing address

4660 MARTIN LUTHER KING JR AVE SW APT C202
WASHINGTON DC
20032
US

V. Phone/Fax

Practice location:
  • Phone: 240-533-6865
  • Fax:
Mailing address:
  • Phone: 240-533-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: