Provider Demographics
NPI:1134543432
Name:EMELDA BARI, KENGONG
Entity type:Individual
Prefix:
First Name:KENGONG
Middle Name:
Last Name:EMELDA BARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7867 RIVERDALE RD
Mailing Address - Street 2:APT 103
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-4035
Mailing Address - Country:US
Mailing Address - Phone:202-765-5490
Mailing Address - Fax:
Practice Address - Street 1:7867 RIVERDALE RD
Practice Address - Street 2:APT 103
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-4035
Practice Address - Country:US
Practice Address - Phone:202-765-5490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA9853374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide