Provider Demographics
NPI:1982059119
Name:BIONDOKIN-NIKONGO, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BIONDOKIN-NIKONGO
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 1:3500 18TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2738
Mailing Address - Country:US
Mailing Address - Phone:202-529-6510
Mailing Address - Fax:
Practice Address - Street 1:3500 18TH STREET NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON DC
Practice Address - State:MD
Practice Address - Zip Code:20018
Practice Address - Country:US
Practice Address - Phone:202-529-6510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DCHHA11977390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program