Provider Demographics
NPI:1407291693
Name:TIDJOH, KOCOU V
Entity Type:Individual
Prefix:
First Name:KOCOU
Middle Name:V
Last Name:TIDJOH
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 1:3159 QUEENS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1178
Mailing Address - Country:US
Mailing Address - Phone:240-481-8579
Mailing Address - Fax:
Practice Address - Street 1:3159 QUEENS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1178
Practice Address - Country:US
Practice Address - Phone:240-481-8579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program