Basic Information
| Provider Information | |||||||||
| NPI: | 1003298613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIMBENG | ||||||||
| FirstName: | THERESIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1836 METZEROTT RD | ||||||||
| Address2: | APT. 2002 | ||||||||
| City: | ADELPHI | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207833475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2404247669 | ||||||||
| FaxNumber: | 2026355780 | ||||||||
| Practice Location | |||||||||
| Address1: | 1731 BUNKER HILL RD NE # EN | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200173026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2404247669 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2015 | ||||||||
| LastUpdateDate: | 06/19/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374U00000X | HHA1121 | DC | Y | Nursing Service Related Providers | Home Health Aide |
No ID Information.