Provider Demographics
NPI:1235913146
Name:DIKONGUE, CALVIN BAUDOUR I
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:BAUDOUR
Last Name:DIKONGUE
Suffix:I
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 1:1679 MONTELLO AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2758
Mailing Address - Country:US
Mailing Address - Phone:202-651-1285
Mailing Address - Fax:
Practice Address - Street 1:1679 MONTELLO AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2758
Practice Address - Country:US
Practice Address - Phone:202-651-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker