Provider Demographics
NPI:1306327929
Name:TIENTCHEU, CHRIS MARLEY DJIEGOUM SR
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:MARLEY DJIEGOUM
Last Name:TIENTCHEU
Suffix:SR
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 1:957 E WEST HWY
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5970
Mailing Address - Country:US
Mailing Address - Phone:240-665-8772
Mailing Address - Fax:
Practice Address - Street 1:957 E WEST HWY
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5970
Practice Address - Country:US
Practice Address - Phone:240-665-8772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant