Provider Demographics
NPI:1700127461
Name:NGUNGOH, DANIEL JUWEL
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JUWEL
Last Name:NGUNGOH
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 1:7635 LAYTONIA DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3855
Mailing Address - Country:US
Mailing Address - Phone:301-792-0424
Mailing Address - Fax:
Practice Address - Street 1:7635 LAYTONIA DR
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-3855
Practice Address - Country:US
Practice Address - Phone:301-792-0424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAHI 103620374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide