Healthcare Provider Details

I. General information

NPI: 1407602741
Provider Name (Legal Business Name): NOT GIVEN NAME NKANGU ATONGSANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 RHODE ISLAND AVE NE
WASHINGTON DC
20018-2835
US

IV. Provider business mailing address

13915 PALMER HOUSE WAY
SILVER SPRING MD
20904-4857
US

V. Phone/Fax

Practice location:
  • Phone: 301-613-8545
  • Fax:
Mailing address:
  • Phone: 312-678-4871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: