Provider Demographics
NPI:1669233466
Name:FON TAAH, KINGSLEY
Entity type:Individual
Prefix:
First Name:KINGSLEY
Middle Name:
Last Name:FON TAAH
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 1:5810 BLAIR RD NW APT 104
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2393
Mailing Address - Country:US
Mailing Address - Phone:202-910-9957
Mailing Address - Fax:
Practice Address - Street 1:5810 BLAIR RD NW APT 104
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2393
Practice Address - Country:US
Practice Address - Phone:202-910-9957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator