=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265055776
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDON CHOO ATAM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2020
-----------------------------------------------------
Last Update Date | 05/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3500 18TH ST NE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20018-2738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-529-6510
-----------------------------------------------------
Fax | 202-529-6570
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3406 55TH AVE APT 401
-----------------------------------------------------
City | HYATTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20784-1021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-839-8420
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | HHA15258
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------