Healthcare Provider Details

I. General information

NPI: 1659948990
Provider Name (Legal Business Name): KALKIDAN YILMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 11/18/2023
Certification Date: 11/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 E WEST HWY # 504
BETHESDA MD
20814-4523
US

IV. Provider business mailing address

9711 WASHINGTONIAN BLVD
GAITHERSBURG MD
20878-7365
US

V. Phone/Fax

Practice location:
  • Phone: 240-647-5625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30733
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: