Healthcare Provider Details

I. General information

NPI: 1750292256
Provider Name (Legal Business Name): JOHNATHAN TAYI FORFU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEW YORK AVE NE STE 221
WASHINGTON DC
20002-1851
US

IV. Provider business mailing address

3346 TEAGAREN CIRCLE SILVER SPRING APT 303 3346 TEAGAREN CIRCLE SILVER SPRING APT 303
SILVER SPRING MD
20904
US

V. Phone/Fax

Practice location:
  • Phone: 202-800-6440
  • Fax: 202-899-6994
Mailing address:
  • Phone: 571-640-0334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number370275
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: