Ngongbo Dylan Foncha

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

BACB783255 Issued in VA

Practice address

5500 Cherokee Ave
Alexandria, VA 22312-3228

Phone

(703) 832-4954

NPI assigned

Jul 7, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657152000000",
    "number": "1497488340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11788 MOHICAN RD",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221921134",
            "telephone_number": "703-403-8070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 CHEROKEE AVE",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223123228",
            "telephone_number": "703-832-4954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONCHA",
        "first_name": "NGONGBO",
        "middle_name": "DYLAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-07",
        "last_updated": "2022-07-07",
        "certification_date": "2022-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "VA",
            "license": "BACB783255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BACB783255",
            "identifier": "BACB783255",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timothy Flynn, M.S., CCC-SLP
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• Keith Foos, DO
• For Eyes Optical Inc
• For Eyes Optical of PA

• Behavior Technician in Alexandria, VA
• Providers in Alexandria, VA by specialty
• Behavior Technician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.