Provider Demographics
NPI:1588404370
Name:JAM, EMMANUEL YONG
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:YONG
Last Name:JAM
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 1:6355 64TH AVE APT B5
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1501
Mailing Address - Country:US
Mailing Address - Phone:240-709-5112
Mailing Address - Fax:
Practice Address - Street 1:3109 MLK JR AVE SE APT 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1576
Practice Address - Country:US
Practice Address - Phone:202-800-4433
Practice Address - Fax:202-722-4903
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator