Provider Demographics
NPI:1124695085
Name:FONJAH, GIDEON TEMBUJONG
Entity type:Individual
Prefix:
First Name:GIDEON TEMBUJONG
Middle Name:
Last Name:FONJAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 13TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3528
Mailing Address - Country:US
Mailing Address - Phone:601-951-5139
Mailing Address - Fax:
Practice Address - Street 1:5601 13TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3528
Practice Address - Country:US
Practice Address - Phone:601-951-5139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide