Provider Demographics
NPI:1558946061
Name:TAKU, HAPPY BIBI
Entity Type:Individual
Prefix:
First Name:HAPPY BIBI
Middle Name:
Last Name:TAKU
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 1:11536 FEBRUARY CIR APT 402
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6997
Mailing Address - Country:US
Mailing Address - Phone:202-386-2924
Mailing Address - Fax:
Practice Address - Street 1:11536 FEBRUARY CIR APT 402
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-6997
Practice Address - Country:US
Practice Address - Phone:202-386-2924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCNA20210440Medicaid