Healthcare Provider Details

I. General information

NPI: 1346153137
Provider Name (Legal Business Name): ANNE KIMBONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10005 MILL CENTRE DR # MD
OWINGS MILLS MD
21117-3885
US

IV. Provider business mailing address

10005 MILL CENTRE DR # MD
OWINGS MILLS MD
21117-3885
US

V. Phone/Fax

Practice location:
  • Phone: 443-985-9514
  • Fax:
Mailing address:
  • Phone: 443-985-9514
  • Fax: 443-985-9514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: