Provider Demographics
NPI:1528863073
Name:TENGONG, BONIFACE MUKUM
Entity type:Individual
Prefix:
First Name:BONIFACE
Middle Name:MUKUM
Last Name:TENGONG
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 1:7847 RIVERDALE RD APT 103
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-4008
Mailing Address - Country:US
Mailing Address - Phone:240-991-3125
Mailing Address - Fax:
Practice Address - Street 1:7847 RIVERDALE RD APT 103
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-4008
Practice Address - Country:US
Practice Address - Phone:240-991-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide