Provider Demographics
NPI:1093230799
Name:TCHUENKAM, CHARLES KAKEU
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:KAKEU
Last Name:TCHUENKAM
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 1:1906 AMHERST RD APT 303
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-6908
Mailing Address - Country:US
Mailing Address - Phone:469-520-2713
Mailing Address - Fax:
Practice Address - Street 1:1906 AMHERST RD APT 303
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-6908
Practice Address - Country:US
Practice Address - Phone:469-520-2713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12947374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide