Provider Demographics
NPI:1467083667
Name:TENDONG-KENG, NICASIUS
Entity Type:Individual
Prefix:
First Name:NICASIUS
Middle Name:
Last Name:TENDONG-KENG
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 1:3635 COUSINS DR
Mailing Address - Street 2:
Mailing Address - City:GLENARDEN
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2600
Mailing Address - Country:US
Mailing Address - Phone:202-594-1526
Mailing Address - Fax:
Practice Address - Street 1:3635 COUSINS DR
Practice Address - Street 2:
Practice Address - City:GLENARDEN
Practice Address - State:MD
Practice Address - Zip Code:20774-2600
Practice Address - Country:US
Practice Address - Phone:202-594-1526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide