Provider Demographics
NPI:1588377873
Name:NIYONKURU, JULIEN
Entity type:Individual
Prefix:
First Name:JULIEN
Middle Name:
Last Name:NIYONKURU
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 1:137 MACREADY AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-2106
Mailing Address - Country:US
Mailing Address - Phone:937-250-4692
Mailing Address - Fax:
Practice Address - Street 1:137 MACREADY AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-2106
Practice Address - Country:US
Practice Address - Phone:937-250-4692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No172A00000XOther Service ProvidersDriver