Provider Demographics
NPI:1164123030
Name:TEKOU FOGANG, SEBASTIAN
Entity Type:Individual
Prefix:MR
First Name:SEBASTIAN
Middle Name:
Last Name:TEKOU FOGANG
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 1:4233 BLAINE ST NE APT 40
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4588
Mailing Address - Country:US
Mailing Address - Phone:202-961-3938
Mailing Address - Fax:
Practice Address - Street 1:4233 BLAINE ST NE APT 40
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4588
Practice Address - Country:US
Practice Address - Phone:202-961-3938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker