Provider Demographics
NPI:1508635855
Name:NONG KUM, WILFRED
Entity Type:Individual
Prefix:
First Name:WILFRED
Middle Name:
Last Name:NONG KUM
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 1:6311 LANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1312
Mailing Address - Country:US
Mailing Address - Phone:240-791-6613
Mailing Address - Fax:
Practice Address - Street 1:6311 LANDOVER RD
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1312
Practice Address - Country:US
Practice Address - Phone:240-791-6613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator