Provider Demographics
NPI:1902255904
Name:TANGWING, FONJONG GODLOVE SR
Entity Type:Individual
Prefix:
First Name:FONJONG
Middle Name:GODLOVE
Last Name:TANGWING
Suffix:SR
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 1:1717 BELLE HAVEN DR APT 201
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4019
Mailing Address - Country:US
Mailing Address - Phone:240-481-6313
Mailing Address - Fax:
Practice Address - Street 1:9284 ADELPHI RD
Practice Address - Street 2:APT 203
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-2037
Practice Address - Country:US
Practice Address - Phone:240-481-6313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12085374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide