Healthcare Provider Details

I. General information

NPI: 1245657634
Provider Name (Legal Business Name): JEAN BERNARD KUATE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 K STREET, 7TH FLOOR
WASHINGTON DC
20005
US

IV. Provider business mailing address

6733 NEW HAMPSHIRE AVE APT 1001
TAKOMA PARK MD
20912
US

V. Phone/Fax

Practice location:
  • Phone: 202-293-2931
  • Fax: 202-293-3480
Mailing address:
  • Phone: 240-374-3935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA9864
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: