Provider Demographics
NPI:1790596617
Name:KOUANDO, YANNICK CHRISTIAN WUNO
Entity type:Individual
Prefix:
First Name:YANNICK
Middle Name:CHRISTIAN WUNO
Last Name:KOUANDO
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 1:3806 LIGHTHOUSE WAY APT 25
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3418
Mailing Address - Country:US
Mailing Address - Phone:240-593-6207
Mailing Address - Fax:
Practice Address - Street 1:3806 LIGHTHOUSE WAY APT 25
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3418
Practice Address - Country:US
Practice Address - Phone:240-593-6207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator