Provider Demographics
NPI:1457820300
Name:DZEKEWONG, JULIUS WIRNKAR (HOME HEALTH AID)
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:WIRNKAR
Last Name:DZEKEWONG
Suffix:
Gender:M
Credentials:HOME HEALTH AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 DODGE PARK RD APT 101
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2025
Mailing Address - Country:US
Mailing Address - Phone:240-825-8770
Mailing Address - Fax:
Practice Address - Street 1:3411 DODGE PARK RD APT 101
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2025
Practice Address - Country:US
Practice Address - Phone:240-825-8770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14155374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide