Healthcare Provider Details

I. General information

NPI: 1225870546
Provider Name (Legal Business Name): KAHAK MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9771 TIGER LILY PATH APT 1D
LAUREL MD
20723-6344
US

IV. Provider business mailing address

12501 PROSPERITY DR STE 315
SILVER SPRING MD
20904-1689
US

V. Phone/Fax

Practice location:
  • Phone: 301-641-1514
  • Fax:
Mailing address:
  • Phone: 301-641-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHEL KAHAK
Title or Position: CEO
Credential:
Phone: 202-722-1700