Provider Demographics
NPI:1033991492
Name:MBEMBA, KEVIN TIMOTHEE
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:TIMOTHEE
Last Name:MBEMBA
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 1:1943 FLOWERING TREE TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5802
Mailing Address - Country:US
Mailing Address - Phone:240-479-5170
Mailing Address - Fax:
Practice Address - Street 1:1818 NEW YORK AVE NE STE 201
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1849
Practice Address - Country:US
Practice Address - Phone:240-479-5170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator