Healthcare Provider Details

I. General information

NPI: 1326960303
Provider Name (Legal Business Name): TANDRE GONGS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 H ST NE APT 412
WASHINGTON DC
20002-9129
US

IV. Provider business mailing address

1600 MARYLAND AVE NE APT 134W
WASHINGTON DC
20002-7658
US

V. Phone/Fax

Practice location:
  • Phone: 202-631-6747
  • Fax:
Mailing address:
  • Phone: 202-336-9324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: