Provider Demographics
NPI:1659616209
Name:BISONG, IVES EYONGETA
Entity Type:Individual
Prefix:MR
First Name:IVES
Middle Name:EYONGETA
Last Name:BISONG
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 1:7600 GEORGIA AVE NW STE 323
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1616
Mailing Address - Country:US
Mailing Address - Phone:202-723-3060
Mailing Address - Fax:
Practice Address - Street 1:6731 NEW HAMPSHIRE AVE
Practice Address - Street 2:APT 201
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4863
Practice Address - Country:US
Practice Address - Phone:234-521-1957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-09
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DCHHA2367374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide