Provider Demographics
NPI:1285996934
Name:SANJE YOKWAN, ENJOH MILDRATE
Entity type:Individual
Prefix:MRS
First Name:ENJOH
Middle Name:MILDRATE
Last Name:SANJE YOKWAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ENJOH
Other - Middle Name:MILDRATE
Other - Last Name:SANJE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1212 LAWLER DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-2158
Mailing Address - Country:US
Mailing Address - Phone:240-706-1203
Mailing Address - Fax:
Practice Address - Street 1:516 N ROLLING RD STE 305
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4142
Practice Address - Country:US
Practice Address - Phone:240-706-1203
Practice Address - Fax:979-606-0062
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR232145363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC049090063Medicaid