Provider Demographics
NPI:1639506934
Name:TANJONG, CYFORA CHIAMOH
Entity Type:Individual
Prefix:
First Name:CYFORA
Middle Name:CHIAMOH
Last Name:TANJONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CIFORA
Other - Middle Name:CHIAMOH
Other - Last Name:ASAAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2065 MAPLE BND
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-6897
Mailing Address - Country:US
Mailing Address - Phone:240-593-1795
Mailing Address - Fax:
Practice Address - Street 1:2065 MAPLE BND
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6897
Practice Address - Country:US
Practice Address - Phone:240-593-1795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH153446164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse