MEDICARE: CANISIA DEFANG NJINKENG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1073475851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANISIA DEFANG NJINKENG

Provider Business Mailing Address
First Line	:	6411 LANDOVER RD APT 303
Second Line	:
City	:	CHEVERLY
State	:	MD
Zip	:	20785-1407
Country	:	US
Telephone Number	:	240-304-6614
Fax Number	:

Provider Business Practice Location Address
First Line	:	6411 LANDOVER RD APT 303
Second Line	:
City	:	CHEVERLY
State	:	MD
Zip	:	20785-1407
Country	:	US
Telephone Number	:	240-304-6614
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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