Provider Demographics
NPI:1801454095
Name:KONGUI, VITALIS SONGEH
Entity type:Individual
Prefix:
First Name:VITALIS SONGEH
Middle Name:
Last Name:KONGUI
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 1:10206 INDIAN SUMMER CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3178
Mailing Address - Country:US
Mailing Address - Phone:202-883-2446
Mailing Address - Fax:
Practice Address - Street 1:10206 INDIAN SUMMER CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-3178
Practice Address - Country:US
Practice Address - Phone:202-883-2446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14458374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide