Provider Demographics
NPI:1598177438
Name:BOCKAI, MAGBUNDEH I
Entity Type:Individual
Prefix:
First Name:MAGBUNDEH
Middle Name:
Last Name:BOCKAI
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 JEFFERSON PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON DC
Mailing Address - State:DC
Mailing Address - Zip Code:20036-0000
Mailing Address - Country:US
Mailing Address - Phone:202-293-2931
Mailing Address - Fax:
Practice Address - Street 1:1822 JEFFERSON PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON DC
Practice Address - State:DC
Practice Address - Zip Code:20036-0000
Practice Address - Country:US
Practice Address - Phone:202-293-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCR1006161163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC141873890Medicaid