Provider Demographics
NPI:1184251183
Name:MUNJONG, CHANTAL ANYEN
Entity type:Individual
Prefix:MISS
First Name:CHANTAL
Middle Name:ANYEN
Last Name:MUNJONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6809 JADE CT
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-1862
Mailing Address - Country:US
Mailing Address - Phone:301-433-5610
Mailing Address - Fax:
Practice Address - Street 1:6809 JADE CT
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-1862
Practice Address - Country:US
Practice Address - Phone:301-433-5610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA15043374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide