Provider Demographics
NPI:1710667662
Name:MUKUM, CHRISTIAN MBAH
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:MBAH
Last Name:MUKUM
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 1:8151 MANDAN TER
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2643
Mailing Address - Country:US
Mailing Address - Phone:202-441-5527
Mailing Address - Fax:
Practice Address - Street 1:8151 MANDAN TER
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2643
Practice Address - Country:US
Practice Address - Phone:202-441-5527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator