Provider Demographics
NPI:1003371683
Name:KA, OMAR
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:KA
Suffix:
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 1:14142 CASTLE BLVD APT 402
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4667
Mailing Address - Country:US
Mailing Address - Phone:301-364-7653
Mailing Address - Fax:
Practice Address - Street 1:3700 9TH ST SE APT 1125
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4046
Practice Address - Country:US
Practice Address - Phone:202-710-0932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty