Provider Demographics
NPI:1841844339
Name:NGOM, MUNDIH
Entity type:Individual
Prefix:
First Name:MUNDIH
Middle Name:
Last Name:NGOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6731 NEW HAMPSHIRE AVE APT 310
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4860
Mailing Address - Country:US
Mailing Address - Phone:240-481-9604
Mailing Address - Fax:
Practice Address - Street 1:6731 NEW HAMPSHIRE AVE APT 310
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4860
Practice Address - Country:US
Practice Address - Phone:240-481-9604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide