Edwin Charles Khonyongwa, LALFA, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

0002092297 Issued in VA

Practice address

7829 Dolleys CT
King George, VA 22485-7085

Phone

(540) 318-3940

Fax

(703) 910-6907

NPI assigned

Aug 28, 2020

Last updated

Aug 28, 2020By the provider in NPPES

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 4

Electronic endpoints 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": "1598572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598572800000",
    "number": "1922611078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5153 SPINNAKER LN",
            "city": "KING GEORGE",
            "state": "VA",
            "postal_code": "224853163",
            "telephone_number": "571-354-9781",
            "fax_number": "703-910-6907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7829 DOLLEYS CT",
            "city": "KING GEORGE",
            "state": "VA",
            "postal_code": "224857085",
            "telephone_number": "540-318-3940",
            "fax_number": "703-910-6907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHONYONGWA",
        "first_name": "EDWIN",
        "middle_name": "CHARLES",
        "name_prefix": "Mr.",
        "credential": "LALFA, LPN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-28",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "VA",
            "license": "0002092297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE AID",
            "identifier": "1401150271",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSING HOME ADMINISTRATOR",
            "identifier": "1732000897",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED PRACTICAL NURSE",
            "identifier": "0002092297",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASSISTED LIVING ADMINISTRATOR",
            "identifier": "1706001017",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.KGmemoryCenter.org",
            "affiliation": "N",
            "endpointDescription": "King George Memory Center LLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5153 Spinnaker Ln",
            "city": "King George",
            "state": "VA",
            "country_code": "US",
            "postal_code": "224853163",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• King George County (King George County Department of Fire, Rescue, & Emergency Services)
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• Licensed Practical Nurse in King George, VA
• Providers in King George, VA by specialty
• Licensed Practical Nurse in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; 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.