Provider Demographics
NPI:1952051716
Name:AJONG, GALLUS NJONGEH
Entity Type:Individual
Prefix:
First Name:GALLUS
Middle Name:NJONGEH
Last Name:AJONG
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 1:6521 LANDOVER RD APT T2
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1425
Mailing Address - Country:US
Mailing Address - Phone:202-460-8165
Mailing Address - Fax:
Practice Address - Street 1:1421 MARYLAND AVE NE UNIT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-5036
Practice Address - Country:US
Practice Address - Phone:646-339-5721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
MDA00201096374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant