MEDICARE: JABOSUNG KIEN CHIMASA CLARA

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	251S00000X	Community/Behavioral Health Agency
2	374U00000X	Home Health Aide	HHA200004480	DC

General Provider Information

NPI Number	:	1629754593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JABOSUNG KIEN CHIMASA CLARA

Provider Business Mailing Address
First Line	:	11463 CHERRY HILL RD APT 101
Second Line	:
City	:	BELTSVILLE
State	:	MD
Zip	:	20705-3624
Country	:	US
Telephone Number	:	240-264-7556
Fax Number	:

Provider Business Practice Location Address
First Line	:	11463 CHERRY HILL RD APT 101
Second Line	:
City	:	BELTSVILLE
State	:	MD
Zip	:	20705-3624
Country	:	US
Telephone Number	:	240-264-7556
Fax Number	:

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

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	01/29/2025

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