Provider Demographics
NPI:1518322353
Name:TONNANG KENFACK, PRINCE
Entity Type:Individual
Prefix:
First Name:PRINCE
Middle Name:
Last Name:TONNANG KENFACK
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 1:8711 PLYMOUTH ST
Mailing Address - Street 2:APT 2
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4053
Mailing Address - Country:US
Mailing Address - Phone:347-486-8225
Mailing Address - Fax:
Practice Address - Street 1:8711 PLYMOUTH ST
Practice Address - Street 2:APT 2
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4053
Practice Address - Country:US
Practice Address - Phone:347-486-8225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health