Healthcare Provider Details

I. General information

NPI: 1699680678
Provider Name (Legal Business Name): IVAN KAMDEM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3022 JAVIER RD STE 152
FAIRFAX VA
22031-4624
US

IV. Provider business mailing address

897 COUNTRYSIDE RD
SEVEN VALLEYS PA
17360-8966
US

V. Phone/Fax

Practice location:
  • Phone: 703-621-1812
  • Fax:
Mailing address:
  • Phone: 717-318-0359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: