Healthcare Provider Details

I. General information

NPI: 1164894630
Provider Name (Legal Business Name): KONFOR NGALA CHUYE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13816 CASTLE BLVD APT 303
SILVER SPRING MD
20904-7334
US

IV. Provider business mailing address

13816 CASTLE BLVD APT 303
SILVER SPRING MD
20904-7334
US

V. Phone/Fax

Practice location:
  • Phone: 202-215-0731
  • Fax:
Mailing address:
  • Phone: 202-215-0731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA11617
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: