MEDICARE: SEIDOU KIENTGA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		MD
2	374U00000X	Home Health Aide		DC

General Provider Information

NPI Number	:	1003166547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEIDOU KIENTGA

Provider Business Mailing Address
First Line	:	1220 E JOPPA RD STE 332
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-5811
Country	:	US
Telephone Number	:	443-353-9547
Fax Number	:	815-301-8671

Provider Business Practice Location Address
First Line	:	1220 E JOPPA RD STE 332
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-5811
Country	:	US
Telephone Number	:	443-353-9547
Fax Number	:	815-301-8671

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2012
Last Update Date	:	01/22/2026

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Directions to “ SEIDOU KIENTGA ” Practice Location

Language	Start Address	Practice Location

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