Provider Demographics
NPI:1932470754
Name:MUKOH, CHICK S
Entity Type:Individual
Prefix:
First Name:CHICK
Middle Name:S
Last Name:MUKOH
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 1:5404 5TH ST NW APT 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3182
Mailing Address - Country:US
Mailing Address - Phone:202-705-4827
Mailing Address - Fax:
Practice Address - Street 1:1220 12TH ST SE STE G35
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3738
Practice Address - Country:US
Practice Address - Phone:202-544-8090
Practice Address - Fax:202-544-8090
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA7413374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide