Provider Demographics
NPI:1720765050
Name:KONGNYUY, DENIS FONGAN
Entity Type:Individual
Prefix:
First Name:DENIS
Middle Name:FONGAN
Last Name:KONGNYUY
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 1:3430 DODGE PARK RD APT 104
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2055
Mailing Address - Country:US
Mailing Address - Phone:240-825-7504
Mailing Address - Fax:
Practice Address - Street 1:3430 DODGE PARK RD APT 104
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2055
Practice Address - Country:US
Practice Address - Phone:240-825-7504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker