Provider Demographics
NPI:1285983569
Name:ICHOK, JOHN MBAH
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MBAH
Last Name:ICHOK
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 1:5819 7TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2007
Mailing Address - Country:US
Mailing Address - Phone:240-701-8087
Mailing Address - Fax:
Practice Address - Street 1:5819 7TH ST NW
Practice Address - Street 2:5819 7TH ST NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2007
Practice Address - Country:US
Practice Address - Phone:240-701-8087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide