Provider Demographics
NPI:1629836796
Name:BAYOU, KASSAHUN TESHOME
Entity Type:Individual
Prefix:
First Name:KASSAHUN
Middle Name:TESHOME
Last Name:BAYOU
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 1:233 UPSHUR ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4847
Mailing Address - Country:US
Mailing Address - Phone:202-733-7144
Mailing Address - Fax:
Practice Address - Street 1:233 UPSHUR ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-4847
Practice Address - Country:US
Practice Address - Phone:202-733-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide