Individual
IVAN CHE NDAMUKONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD, PA-C
Contact information
Practice address
1040 UNIVERSITY BLVD STE 205, PORTSMOUTH, VA 23703-2650
(757) 391-7370
Mailing address
2113 CHESTERFIELD LOOP, CHESAPEAKE, VA 23323-6670
(252) 412-9548
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110008765
VA
Other
Enumeration date
01/04/2022
Last updated
08/29/2022
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