Provider Demographics
NPI:1770902264
Name:AYONISEH, KILIAN (HHA)
Entity type:Individual
Prefix:MR
First Name:KILIAN
Middle Name:
Last Name:AYONISEH
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:MR
Other - First Name:KILIAN
Other - Middle Name:
Other - Last Name:AYONISEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HHA
Mailing Address - Street 1:6419 LANDOVER RD APT 202
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1411
Mailing Address - Country:US
Mailing Address - Phone:301-832-1234
Mailing Address - Fax:
Practice Address - Street 1:6419 LANDOVER RD APT 202
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1411
Practice Address - Country:US
Practice Address - Phone:301-832-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-11
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC10583374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide