Provider Demographics
NPI:1356141717
Name:KUFOR, LONGCHI NDONGLA
Entity type:Individual
Prefix:
First Name:LONGCHI
Middle Name:NDONGLA
Last Name:KUFOR
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 1:21854 DENTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-6012
Mailing Address - Country:US
Mailing Address - Phone:612-458-7768
Mailing Address - Fax:
Practice Address - Street 1:21854 DENTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-6012
Practice Address - Country:US
Practice Address - Phone:612-458-7768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-15
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN825769164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse