Provider Demographics
NPI:1770079121
Name:DIKONG, GABRIEL NJOH (DRPH)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:NJOH
Last Name:DIKONG
Suffix:
Gender:M
Credentials:DRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 DECATUR CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-3114
Mailing Address - Country:US
Mailing Address - Phone:513-293-3621
Mailing Address - Fax:513-429-5222
Practice Address - Street 1:716 DECATUR CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-3114
Practice Address - Country:US
Practice Address - Phone:513-648-9048
Practice Address - Fax:513-648-9048
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0351374Medicaid