Healthcare Provider Details

I. General information

NPI: 1912749631
Provider Name (Legal Business Name): RACHEL N KAYONGO D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 LIVINGSTON RD STE 105
FORT WASHINGTON MD
20744-4973
US

IV. Provider business mailing address

1802 STEWART AVE
LINCOLN PARK MI
48146-3556
US

V. Phone/Fax

Practice location:
  • Phone: 301-857-5736
  • Fax:
Mailing address:
  • Phone: 818-770-6442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number268664
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: